WI senate fights over "oral chemo mandate".

[HereSince1628]

Is chemo billed as drug or as hospital treatment? It currently makes a huge difference on who pays the bill.

Oral chemotherapy drugs can run $120,000 a year, imposing enormous costs on patients whose insurance plans treat them as pharmaceuticals for which the patients must pay much of the expenses.

For some cancers, such as chronic myelogenous leukemia and multiple myeloma, crucial drugs are taken orally and are covered by a health plan's prescription drug benefit. Some health plans cover only part of the cost of expensive prescription drugs, with no limits on out-of-pocket spending.

By contrast, cancer drugs administered intravenously at hospitals or clinics are covered once a patient hits his or her deductible as part of health plans' medical coverage.

Wisconsin's legislature has refused to embrace the ACA, and the consequences of that resistance are emerging. Patients whose polices fall under federal oversight have different rules on caps for their out-of-pocket costs than those under WI oversight.

A bill to help protect all Wisconsin consumers from the high costs of anti-cancer drugs is now being blocked from coming to the floor of the state senate, ostensibly because the WI mix of federal and state regulations imposes unequal responsibilities on insurers.

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Sen. Jon Erpenbach (D-Middleton) said... "I think with certain GOP legislators, the insurance industry has more pull than people with cancer," he said. "I don't know how else to put it."

Opponents of the bill disagree, saying it's complicated because as a state, Wisconsin can affect only the portion of the insurance market that it regulates. That means the state would impose an extra responsibility on some insurers and their customers while other businesses falling under federal regulations would continue without the extra requirement.

The Wisconsin Association of Health Plans has labeled the bill "The Oral Chemotherapy Mandate" and contends it "represents a government attempt to restrict the market." Phil Dougherty, senior executive officer of the association, said it would set a bad precedent and would also be unfair to other patients taking expensive medications.

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Read more from Journal Sentinel: http://www.jsonline.com/news/statepolitics/senate-panel-maneuver-prevents-cancer-drug-vote-b99223846z1-249805561.html#ixzz2vweZW5Vj
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[Scuba]

1. "I think with certain GOP legislators, the insurance industry has more pull than people with cancer"

Yeah, Jon, me too.

[HereSince1628]

2. It's putting some strain the WIGOP, it's hard be against helping cancer victims.

Alberta Darling, my senator and a Koch club member, is in favor of passing the bill.

[Scuba]

3. Alberta? Really? I wouldn't have guessed that she has a conscience. Or a soul.