TMA Testimony: HB 438 Coverage of Chemo Drugs

Testimony: House Bill 438 by Rep. Senfronia Thompson, Sen. John Carona

Senate State Affairs Committee  

 By: Debra Ann Patt, MD, MPH
May 2, 2011     

Chairman Duncan and members of the committee, it is a privilege for me to speak with you today on behalf of the Texas Medical Association (TMA), which represents 45,000 physicians and medical students. My name is Debra Ann Patt, MD. I am a physician in private practice at the Texas Oncology Cancer Center here in Austin. I am board certified in oncology and hematology and have been caring for cancer patients for many years. I am also a member of the TMA’s Committee on Cancer and a speaker for the Physician Oncology Education Program.  

I am here today in support of House Bill 438. This legislation would make a significant difference to ensure physicians can provide the best treatment options for Texans with cancer. Cancer causes more than 38,000 deaths each year in Texas, and is second only to heart disease. This year alone, more than 107,000 Texans will be diagnosed with cancer. These are the patients that I treat and care for every day.    

There are more than 200 different types of cancer. However, thanks to new research and technology, we continue to make significant progress in treating people with cancer. Today, physicians have many different types and combinations of cancer treatments available — and more are being developed.  The growing availability of oral anticancer drugs — more commonly called chemotherapy — is one of the most significant improvements made in cancer treatment. Oral cancer treatments include pills, capsules, or liquids.  

Oral anticancer medications are a critical tool in the arsenal physicians have to care for cancer patients. For some patients they are the only treatment for their cancer. For example Sutent® and Nexavar® are the mainstays of chemotherapy for kidney cancer. There are not effective IV options. Oral chemotherapy is here to stay — these drugs represent more than 25 percent of the 400 chemotherapy drugs currently under development.    

A cancer patient faces physical, emotional, and financial challenges. During this difficult time, one of the most important things we can do for our patients is to make the treatment plan as easy to understand as possible. For many cancer patients, taking an oral anticancer therapy provides more flexibility and convenience in their treatment plan. Patients can opt to have their cancer treatment in their home as opposed to in the clinic or hospital-based setting. And, one of the greatest things about these drugs is that they allow cancer patients to live active and productive lives while undergoing treatment.  

Oral anticancer therapies cannot be an effective treatment if the patient cannot afford the drugs or if their insurance doesn’t cover the cost. Often oral cancer drugs are covered as a prescription benefit rather than as a medical benefit. Typically, prescription benefits have higher cost-sharing requirements or out-of-pocket costs for patients. And when a product is not covered by the patient’s insurance or the patient has to pay more for the cancer drugs, that can interfere with the patient’s ability to follow the treatment plan.    

The recent study on oral anticancer treatment parity conducted by the Texas Department of Insurance confirmed many patients lack the health insurance coverage needed to purchase oral cancer medications. Intravenous cancer treatments are covered by most insurance plans. We hope this bill will extend coverage to oral anticancer therapies, which are typically included in prescription drug plans.   

The annual coverage limit of most prescription drug plans often is only enough to supply the patient with a single month’s worth of oral chemotherapy. For example, if a patient has metastatic breast cancer and is given the option of taking an oral agent, Xeloda®, or an intravenous agent, Eribulin, the choice to take Eribulin by infusion in an office may be a financial one alone.  

Texas lawmakers have repeatedly demonstrated a strong commitment to prevent and fight cancer. In 1985, you passed legislation requiring a state strategic plan for cancer. In 2007, you provided funding so that more women could be screened for breast and cervical cancer and get their treatment covered under Medicaid. And last session, you authorized funding for the Cancer Prevention Research Institute of Texas. Texas is a leader in the fight against cancer. House Bill 438 is one more step you can take to ensure Texans diagnosed with cancer have the best chance for survival and a productive life.   

I thank you for your attention and welcome any questions you may have. TMA welcomes the opportunity to work with you in your consideration of this legislation.

82nd Texas Legislature Testimonies 


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