Digging around laws, insurance providers, etc., gives some interesting information

I came across a blog by an oncologist discussing the cost of Abiraterone (a chemo drug which Peter had, but which failed after 4 months).  A patient of his had an enormous copay for the drug, something like $2300/month.    I’m all too aware of this sort of pricing, but thankfully (in a weird way) Peter is over 65 and therefore subject to Medicare A and B.  However, in a bizarre move by the Congress at some point in the past,  Medicare does not cover the cost of prescription drugs (no doubt fueled by the pharma lobbies).   This has been going on for some years, and there are a series of quite baroque procedures (not to mention expense) for getting adequate drug prescription coverage.

But I digress – what I found out from this blog is that there is something called oral parity.  Now I knew from my research that chemo drugs administered through infusion, and therefore done in a clinic or similar, are covered both by Medicare and private insurers, under a reasonable copay situation.   An oral parity law has been enacted in 19 states thus far, with quite a few considering such legislation.  This means that pill-based chemo drugs (such as the Abiraterone mentioned above, and the Xtandi drug Peter takes) will be treated on the same basis as the infusion-based drugs.    Looking at the map of states which enacted legislation, and those which are considering it, it’s interesting (and unfortunately predictable) to note that those states seemingly avoiding the whole issue tend to be the most conservative ones, including our current home state of North Carolina.

However, I’ve joined the discussion group to help promote oral parity nation-wide which is  Patients Equal Access Coalition, or EEAC.  The blogging oncologist is Dr. Craig Hildreth, and the blog is in cancernetwork.com, for anyone who is interested.  By the way, he calls himself the happy oncologist.

So that’s today’s news.   And the message here is to read everything.  Sure it’s ok to dismiss the vast majority of what’s out there, but occasionally a gem emerges in a the goop.   However, this particular blog is in an authoritative site, but I normally have gone right by the happy oncologist.

Meanwhile, we’re very much enjoying a visit from Pam Millar, Peter’s sister, who flew for around 24 hours, with an elapsed time of 34 hours to get here from Port Elizabeth, South Africa.   More on the visit in the next post.



This entry was posted in Cancer and tagged , , , , , , , , . Bookmark the permalink.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s