The Joplin Globe, Joplin, MO

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March 14, 2014

Cancer patient, doctor, lawmaker laud chemo-pill cost equalizer

About a year and a half ago, Carl Hayes was diagnosed with melanoma cancer — but he considers himself fortunate.

A short time before his diagnosis, an oral prescription medication was developed to specifically target melanoma.

The pill can be used for treatment if the cancer has spread to other parts of the body or cannot be removed by surgery. A certain type of abnormal gene must also be present.

Hayes, 65, said his doctor suggested he undergo a test to verify he had the mutated gene.

“When they found out that was positive, it basically opened up the door for oral medication,” Hayes said.

Dr. Anisa Hassan, a hematologist/oncologist at Freeman Cancer Institute, has been working with cancer patients for more than 20 years.

In the past 10 years, Hassan said, she has seen “an evolution in the treatment of cancer patients.”

“Thirty years ago, all we did was chemotherapy,” she said, adding the treatment can cause severe side effects, including hair loss, nausea and vomiting, and making a patient more susceptible to infection.

But with the development of oral chemo pills, the medicine targets the tumor rather than targeting the body, she said, lessening the severity of potential side effects.

“Now, we’re starting to make the cancer a chronic disease instead of rapidly fatal,” Hassan said.

However, there have been occasions when Hassan wanted to prescribe oral treatment, but some patients could not afford it.

Earlier this month, a bill that would require insurance companies to charge patients the same out-of-pocket costs for chemotherapy pills as they do for chemotherapy treatments pumped directly into the bloodstream was sent to Gov. Jay Nixon after Senate and House approval.

Rep. Sheila Solon, R-Blue Springs, and Sen. Ryan Silvey, R-Kansas City, sponsored the bill.

Silvey said the topic hits him close to home.

“I had seen the issue around for a couple years and never was that involved,” he said, until a friend was diagnosed with brain cancer and was prescribed an oral treatment.

“That really highlighted the situation and made it real,” he said. “Watching someone you care for deal with this disease or treatment makes it personal for everyone.”

Patients are often charged much more for oral chemotherapy because it is handled as a pharmaceutical benefit, Silvey said, and there’s no cap on cost. Intravenous treatments often only cost the standard co-payment for an office visit.

Solon learned from watching other states that have passed the legislation, she said, and saw it was important to keep out-of-pocket costs under $100 because some patients would split pills or skip days. Others would just walk away.

If approved by the governor, the law would take effect July 1, 2015, and would cap the out-of-pocket expense for a 30-day supply at $75.

Solon said the bill had overwhelming support in the House and Senate, and she’s certain the governor will sign it.

“This is a revolutionary new way that we’re going to be treating cancer in the future,” she said. “So, the folks who are battling cancer, we need to give them all the options we can to fight this terrible disease.”

Hassan said the oral pills are a much better way of treating cancer.

“Anybody who has the mutation for which they will respond to a certain oral drug, they should get that drug instead of chemo,” she said. “It makes so much sense.”

Hassan said from her perspective, making the pill affordable is extremely important, because it would enable her to provide the best possible treatment available.

She cited a specific type of cancer, saying in the past, a patient would’ve endured toxic treatments or maybe a transplant.

“They would’ve suffered so much and still would’ve died,” she said.

Hayes said when he was first prescribed the oral treatment, he missed quite a bit of work and generally felt lousy. But once his dosage was lowered, he began living a relatively normal life.

Now, his cancer is in remission. He still makes monthly visits to Freeman Cancer Institute and will remain on the medication.

The biggest side effect, he said, is sensitivity to sun. He also experiences joint pain that can be severe at times, and rashes can develop.

“It’s a lifetime treatment,” he said. “But it sure beats the alternative.”

Hayes, of Riverton, Kan., was able to afford the treatment without much concern and wants others who are diagnosed to have the same peace of mind.

“(Cost) shouldn’t be an obstacle if there’s a modern, advanced type of treatment that would be the best option,” he said. “Oral medication should be on more of a level playing field with the old traditional type of treatment.”

Hassan said she wants to emphasize there is a lot of investment that goes into researching different ways of treating cancer.

“If for some reason our patients cannot get it, then we are really wasting such an important resource where we’ve been putting so much money to develop a powerful drug that can change the natural history of a disease.”

Other states

Rep. Sheila Solon said 27 states and the District of Columbia already have enacted laws requiring equal coverage for oral and intravenous chemotherapy treatments.

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