OCEAN CITY — The Kathleen A. Mathias Chemotherapy Parity Act of 2012 has sailed through the Senate and is expected to breeze through the House of Delegates soon.
The act, named after Mathias, a beloved Ocean City resident who lost her battle with cancer last August, aims to level the playing field for insurance coverage for both the intravenous and oral forms of chemotherapy.
Last month, State Senator Catherine Pugh (D-40), with co-sponsorship by 25 other state senators including Sen. Jim Mathias (D-38), introduced the legislation aimed at ensuring insurance companies, health service plans and health maintenance organizations provide equal levels of coverage for chemotherapy regardless of whether or not the treatments are administered intravenously or orally.
Kathy Mathias was a long-time municipal employee and the wife of Sen. Jim Mathias. She earned high marks in the community for her courage and support of the American Cancer Society throughout her 14-year battle with cancer.
The legislation, if approved, would prevent insurance carriers, health service plans and HMOs from placing limits on coverage or expanding co-payments on chemotherapy treatments administered orally. While most carriers cover intravenous chemotherapy treatments entirely, orally administered treatments often come with higher co-pays, big deductibles or coverage limits. The bill is an attempt to make both forms of treatment equal in terms of insurance coverage.
“There are a variety of reasons why doctors believe in some cases the pill is better than the drip,” said Mathias last month. “This bill would ensure parity when it comes to coverage and put the decision in the hands of the doctors to make a determination of what is best for their individual patients.”
Mathias said when both forms of the same chemotherapy treatment are available, the insurance carriers often cover the IV form completely while putting coverage limitations on the pill form, which often cost hundreds of dollars per pill. Since the pills are a fairly recent treatment option, many of the insurance carriers are uncertain how to fit them into their traditional coverage areas, resulting in higher premiums or deductibles, lower coverage limits and greater out-of-pocket expense for the patients and their families.
The legislation passed the Senate 45-0 last Friday and the conforming legislation in the House is not expected to have any difficulties, according to lawmakers.
“I’m very gratified. Kathy is still at work. Her inspiration still carries on,” said Jim Mathias yesterday. “This allows those people who need those drugs now to get it now. This bill will open up potential opportunity of helping over 700,000 Marylanders who will now be able to get these drugs more affordably. Once the bill passes and we get it signed and the insurance companies start to look at how it affects their policies, we should be able to get these drugs into the people’s hands.”
Once the bill is approved by the House, as expected, it will need to be signed by the governor and should take effect later this year.
“At the same time, these doctors will be able to argue the law is coming and the sensitivity of all our stakeholders working together — our doctors, insurance companies, oncologists and cancer patients — should be able to be very persuasive even though it’s not law. I think we will be able to make that case for those who need drugs now,” Mathias said.