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There ought to be a law - Pill Form Chemotherapy not covered

My friends at the Leukemia & Lymphoma Society asked me if I would volunteer (ouch, there I go again) and tell my story at the Commonwealth of Massachusetts State House.  We met with State Representatives and Congressmen to tell them about a historical quirk in Massachusetts law that sets insurance coverage for certain types of pharmacy costs at much lower than other pharmacy and medical care costs.  The original law was established to set a scale of pharmacy reimbursement coverage but at that time, lawmakers didn't know about the current emerging pill form chemotherapy. So rather than sitting in an infusion room chair as I have for many hours, I can take a pill-form of chemo at home.  I still have to pick up the pills at Dana Farber regularly because they are strictly controlled under a Clinical Trial, but I don't have to hang around and be exposed to other immuno-compromised patients, I don't lose time from work sitting in an infusion room chair for 4-6 hours, I save $25-000 to $30,000 in infusion chemo costs, plus the DFCI staff and facility costs.  My pill form's anticipate cost will be a fraction of infusion cost.

But here's the glitch.  Because it's pill-form, it's considered Pharmacy expense and classified as a special category IV (that's roman numeral 4 not IV, how ironic) accordingly reimbursed only at 70%, a guesstimate of more than $15,000 year billed to the patient.  But if the patient takes chemo by infusion it's reimbursed at 100%, no charge.  This represents very substantial savings for the insurance provider, healthcare service provider and taxpayers who often pick up part of the tab, but the patient gets whacked with a whopping 30%.  None of us is asking for a hand out, this in fact saves everyone money, represents a serious way to cut healthcare costs a problem for all of us.  

There is a piece of legislation Senate Bill S .1070 that is not an insurance mandate or demands anything except tells the insurance companies that if the chemotherapy or other therapy, biologic or immunotherapy costs less than intravenous (IV) infusion chemotherapy, they have to provide the same level of coverage for patients that pay for medical coverage.  It's simply a parity option, don't take advantage of an out of date law.  

We're doing some gentle arm-twisting to get the Senate President to put this bill on the docket before the end of July. I've not heard any vocal opposition about this bill.  But my biggest fear is it would fail because of misinformation, lack of information, or simply ran out of time, scenarios all too familiar for cancer patients.   Read more in the links below and if you're motivate to help please call your state Senator and Representative. 

The Leukemia & Lymphoma Society is spearheading this most important effort.  


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