Bill aims to eliminate costly difference between oral, IV chemotherapy for Utah patients

Published: Tuesday, Feb. 19 2013 7:25 p.m. MST

Nephi resident Cody Anderson pays $5,000 a month for the oral chemotherapy medication that has given him a new lease on life and a normal life expectancy, which is phenomenal for the rare form of leukemia he has. 

"Health insurance is a gamble. … Insurers gamble that you won't get sick," Anderson said, adding that he had always carried a plan that was sufficient for his needs until he became a cancer patient.

"The insurance companies are forcing us to choose between life and death," said his wife, Shelly Anderson. "We should not have to face financial devastation because of a cancer diagnosis."

Bramble said the average monthly costs to insurers for the most widely used 18 IV chemotherapy treatments is $12,820. For the most common 13 oral chemotherapies, the costs pale in comparison, at $5,699 per month.

He is working with those in opposition to the bill, mainly representatives from the health insurance industry, and said there is ample evidence that more could be done for patients already dealing with a frustrating diagnosis.

"Oral chemotherapy is the wave of the future," said leukemia survivor Jamie Toftum, who lives in Vernal.

She said her once-terminal diagnosis is treatable with oral chemotherapy.

"In 20 years, people will not go in for IV chemotherapy treatment. They will take a pill at home," Toftum said.

Without patient assistance programs offered by her local pharmacy and drug manufacturers, Gubler said the medication prolonging her life wouldn't be an option. It helps to shave off more than $1,000 each month. Neighbors and friends have also helped with medical costs through various fundraisers over the years.

With insurance coverage, Toftum's copay for three-pill-a-day, twice-daily regimen of Xeloda, the anti-cancer treatment used primarily for breast cancer and other types, is $1,300 a month.

Patients must be accepted for such programs that help with the cost of a medication, and while some only provide temporary assistance, a lot of people are denied participation based on existing insurance coverage and/or income levels.

Oral chemotherapy doesn't come completely without side effects. Gubler deals with an annoying rash that appears on her hands and feet, causing rough and scaly skin. And there are others, but they are nothing compared to what she's been through and would be going through if subjected to additional IV treatments.

"For me, the oral chemotherapy is just as effective as the IV chemo. They are both chemo, they are used for the same purpose, so why are they covered differently?" Gubler asked, adding that they have paid more than $20,000 out-of-pocket for her treatment since she was first diagnosed.

Because her condition is now chronic, she said she expects to pay as much or more for medical care for the rest of her life.

"It would be such a relief to not have to worry about this expense. As you can imagine, the emotional and physical part of having cancer and raising a family is more than enough stress in our lives right now," Gubler said.

E-mail: wleonard@desnews.com

Twitter: wendyleonards

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