Cancer survivors have many additional problems in their life. I guess the most significant problem is that we have a life threatening illness. So, why are we forced to have to worry if our medications will be paid for or if we are able to afford to pay for them? When we are fighting for our life we shouldn’t also have to fight to get or medications, especially chemotherapy.
Most people don’t realize it but the type of treatment your doctor prescribes might determine how your insurance company will pay. When you are prescribed intravenous (IV) chemotherapy you will go to an office or hospital. Since you are required to go to see a healthcare professional your insurance company will pay the bill as a medical benefit requiring you to just pay a limited co-pay.
When the doctor prescribes oral anti-cancer medications like Zytiga or Xtandi your insurance coverage will usually come under your prescription drug benefit. In most cases you’re your co-pay or co-insurance will be significantly higher than if the treatment was administered in a doctors office or in the hospital! This can translate to thousands of dollars of extra cost to an oral chemotherapy drug user.
For some survivors their oral medications can only be administered using this more expensive option (like Xtandi and Zytiga.
This higher cost can run into thousands of dollars forcing too many people to not be able to purchase their drugs. People who fail to take their drugs become sicker and eventually require even more treatment at possibly even a greater cost to the insurance company and to society.
The good news is that a number of states have adopted or are considering legislation that requires health insurance companies to cover oral anti-cancer drugs like they cover IV cancer therapies. These bills are called parity bills.
Does your state have a parity bill? You can find out by going to Prescription Princess. Prescription Princess also has a link where you can obtain coupons for medications.
Joel T Nowak, M.A., M.S.W.