Council of State Governments

Transcription

1 Council of State Governments December 11, 2009 Orally Administered Chemotherapy: An Oregon Family s Story By Heather Stauffer Kirk

2 Diagnosis My Dad, Chuck Stauffer, is a fourth generation Oregon hop and filbert farmer, and the heart of our family. Diagnosed with a malignant brain tumor in December 2005 at age 58.

3 Treatment My Dad underwent brain surgery. Oral chemotherapy and radiation were recommended simultaneously for 42 continuous days.

4 Oral Chemotherapy A pill that can be taken at home is generally better tolerated and less invasive than IV or injected forms.

5 Insurance and Oral Chemotherapy Chemotherapy was not covered by his health insurance equal to IV or injectable forms. His out-of-pocket co-pay was over $5,500 for his first round of chemo. This was after meeting his deductible and out-of-pocket maximum. His chemotherapy treatment was to continue monthly for at least two years.

6 Options Pay $1,715 every 23 days for an indefinite amount of time, or choose a less effective form of treatment against his doctors recommendations. His insurance company denied our appeal.

7 Oregon s Senate Bill 8

8 SB 8 Legwork Formed a work group, built a coalition and drafted key language.

9 Senate Bill 8 Support I spent a great deal of time at the Capitol Building in Salem, Oregon meeting personally with key legislators. Many of them chose to co-sponsor the bill. Legal opinion stated that SB 8 was not a mandate under Oregon law, as it did not require insurance companies to cover anything new.

10 SB 8 in Committee I carefully researched and prepared my testimony to present before the Senate Health Care Committee. I was fortunate in the fact that the lobbyist for my Dad s insurance company (Regence Blue Cross Blue Shield of OR) was empathetic, wise and experienced. He offered testimony in support of our Bill, and worked with RBCBS to determine what sort of changes were feasible for them to implement. SB 8 passed through both Committees unanimously.

11 Unexpected Resolve Just before the bill reached Committee, Regence Blue Cross Blue Shield of Oregon issued full reimbursement to my Dad for his chemotherapy out-of-pocket expenses. Along with other unsuspecting Oregon cancer patients in same insured category, he received a check for thousands of dollars. I remained committed to eliminating this problem for other cancer patients in the future.

12 Senate Bill 8 on the Senate and House Floors SB 8 passed the Oregon Senate unanimously. SB 8 passed the Oregon House unanimously, but for one vote.

13 Senate Bill 8 Becomes Law On June 25, 2007, Senate Bill 8 was signed by Oregon Governor Ted Kulongoski. Insurance companies were left to determine the best way to implement by January 1, Contacted by others interested in implementing similar legislation in other states.

14 Impact of Senate Bill 8 A few patients had existing insurance benefits which were adversely affected by SB 8. This transition only exists in the first year, when existing patients are aware of a change to their plan. Compared to the inequality that existed prior to SB 8, these changes were relatively insignificant. The bill accomplished my objective, and has made oral chemotherapy more accessible to Oregon patients and treated fairly by insurance companies.

15 The Present Our family has been able to enjoy 2009 with my Dad in good health.

16 National Impact Similar legislation has passed in several states, including Hawaii, Indiana, Iowa, and Vermont. HR 2366 introduced in Congress by NY Congressman Brian Higgins, following a NY Times cover story on my Dad s experience.

17 Next Steps Orally administered chemotherapy is clearly the wave of the future. It is my hope that insurance companies take it upon themselves to provide adequate coverage to all cancer patients. And if they don t, I hope that each state ensures equal treatment for all forms of chemotherapy. Senator Kennedy s battle and oral chemotherapy treatment helped raise awareness.