A Rep. Samantha Steckloff (D-Farmington Hills) bill providing parity for cancer patients who take treatments orally at home was introduced in the House on early this month.

Currently, chemotherapy received intravenously at a hospital or clinic is covered by insurance, and is cheaper because it’s billed as a service. Oral chemotherapies, however, are only covered if an IV form is not available, and they have a more expensive out-of-pocket cost because they’re billed as a drug.

Steckloff said the types of chemotherapy available in both forms are “staggering”, leading Michiganders who want to take treatments orally to pay completely out-of-pocket.

Her own oral chemotherapy medication is only covered because there isn’t an IV alternative available, but Steckloff said the ability to take an oral drug has allowed her to live a higher quality of life and continue working as a legislator.

She explained the process of traveling to a clinic for chemotherapy, which can take all day long, every few weeks. You have to take a day off work to receive the therapy and a day after to recover, she said, and it feels like you’re “constantly battling a diagnosis you can’t seem to get out from underneath.”

Approximately 640,000 Michiganders have used chemotherapy, Steckloff said.

Providing an oral version of the same treatment would allow them to remain in their homes, work and interact with others and “frees them from unneeded stress that comes along with fighting a life-threatening illness.”

Steckloff said HB 4071 , a reintroduction of legislation introduced most recently by former Rep. Daire Rendon, would provide parity for those fighting cancer at home by mandating that oral anticancer medicines are not more financially restrictive than their intravenously administered counterparts.

The bill also places a $150 cap on co-pay for a 30-day supply of orally administered anticancer drugs beginning Jan. 1, 2025, and language states that increasing cost-sharing requirements or imposing stricter treatment limitations isn’t an option for health insurance providers.

Steckloff said the legislation received bipartisan support when it was introduced in multiple legislative terms, but “we still haven’t been able to get this bill to the governor’s desk.”

“Meanwhile, people with cancer have been forced to put their lives on hold to receive chemotherapy in a hospital or clinic instead of taking oral chemotherapy from the comfort and safety of their homes,” she added.

This is due to a disconnect with insurance companies, Steckloff said, because at the end of the day it will cost them money.

But she said conversations have been ongoing with insurance providers, and “they know this is the year.”

Steckloff added that for businesses, the cost of losing an employee a few days every two weeks is much more financially strenuous than a small increase in premiums.

Though the Michigan Association of Health Plans hasn’t taken a formal position due to their legislative analysis process, executive director Dominick Pallone said the Association typically opposes price mandates on things like oral chemotherapy drugs.

He said the group believes safety and positive clinical outcomes should be the basis of coverage, not parity.

According to past bill analysis, he said it’s believed the bill would affect a “fraction of 1% of the population” at 0.6%, due to a large portion of cancer diagnoses being in individuals over 65 and covered by Medicaid, along with exempted plans and the uninsured portion of the population.

For all other ratepayers, he said, the bill would simply hike up their premiums.

But Steckloff said parity should matter for cancer patients.

As a breast cancer survivor, Steckloff said the most important thing is making sure Michiganders know that a cancer diagnosis is not the end of the world, and that there is an intricate and loving community out there to support them.

“This is my first bill on purpose,” Steckloff said.

“I know firsthand how radically a cancer diagnosis changes your whole life,” she said. “Allowing cancer patients to receive the care they need while maintaining a sense of normalcy will be life-changing.”

The bill is supported by the American Cancer Society, who have advocated for the passage of oral chemotherapy fairness legislation for the past 10 years, said American Cancer Society Cancer Action Network government relations director Molly Medenblik.

“We are very much looking forward to working with Rep. Steckloff on this important legislation,” she said, “and I know all the patients, family members, volunteers and many others who have worked on this legislation throughout the years are excited to finally get it across the finish line.”

Megan Landy, a senior manager with the ACS, said her father’s diagnosis with stage four lung cancer highlighted the importance of oral chemotherapy.

“He was told the prognosis was six months,” Landry said. “Because of oral chemotherapy, which, for him, was the only option to treat his lung tumors, he lived with his cancer for four and a half years.”

She said her father had minimal side effects during treatment, and she’s hopeful his story will help influence Michigan lawmakers to “pass a bill that would change the lives of countless individuals.”

Steckloff said 43 states currently offer similar forms of cost protection for oral cancer treatment, and studies by insurance commissioners have shown there is minimal impact on consumer premiums that provide chemotherapy treatment parity.

The bill was supported upon introduction by the Michigan Society of Hematology and Oncology and the Leukemia and Lymphoma Society.

It was referred to the House Health Policy Committee.

This story courtesy of MIRS, a Lansing-based news and information service.