Kansas City Business Journal
Lily Lieberman

Cancer patients can get their chemotherapy orally, via a pill, when receiving it intravenously is inconvenient or impossible. Both are equally effective.

One catch: Although the medicine is the same regardless of its form, the pill costs more than the IV, and that's just not right, said Dr. Roy Jensen, director of The University of Kansas Cancer Center.

Jensen thinks the pricing structure for oral and intravenous chemotherapy should be treated the same, giving patients more control of their health care. He thinks the federal government should mandate identical coverage.

Although medication in pill form can be more convenient for cancer patients, its high price may deter access and prevent adherence.

“Would you rather have me stick a needle in your arm and give you a drug that way, or would you rather take a pill with a glass of water? I have a 100 percent response rate to this question saying they’d rather take a pill,” Jensen said. “But for whatever reason, we have developed a system whereby those two things are reimbursed completely differently, and it’s not necessarily connected in any logical way. But that's sort of true for health insurance and medical care in this in this world as it is.”

From a scientific standpoint, Jensen said, the integrity of the drug and its efficacy are the same, but insurance companies reimburse IV chemotherapy as a medical benefit and consider less-invasive oral chemotherapy to be part of a patient’s drug plan, which tends to be far less generous. The disparity, he said, comes down to money.

“At its core, that’s what it boils down to," he said. "It doesn't make a lot of sense, other than that it benefits folks that are coming out with a new oral drug.”

The complexity of reimbursement systems and multiple reimbursement channels from private insurance companies can pose economic barriers for cancer patients with low incomes who want to be treated with oral chemotherapy.

“The issue is that state insurance commissioners are responsible for health care plans that fall under both state auspices and federal auspices — and roughly half fall under each category,” Jensen said.

Currently, 43 states — including Kansas and Missouri — have passed “oral parity” laws that require health insurers to cover oral chemotherapy using the same pricing structure as IV treatment.

U.S. Sens. Jerry Moran, R-Kan., and Tina Smith, D-Minn., recently introduced the Cancer Drug Parity Act, which would mandate that oral cancer drugs be covered in the same way as traditional IV chemotherapy on a federal level.

“One of the beauties of this bill is that it’s one of the least partisan things out there," Jensen said. "It’s a commonsense measure as witnessed by the fact that well over 40 states have already adopted this.”

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