OCEAN CITY — In one of the few examples of unanimous support for anything in the current General Assembly session, state lawmakers on both sides of the aisle last week approved the Kathleen A. Mathias Chemotherapy Act of 2012.
On March 9, the Senate unanimously passed the bill aimed at leveling the playing field for insurance coverage for both the oral and intravenous forms of chemotherapy with a 45-0 vote. Last Friday, the House of Delegates followed suit, approving the measure by a resounding 137-0 vote.
Kathy Mathias, who passed away last August, was a longtime municipal employee for the town of Ocean City, including a stint as City Clerk, and the wife of former mayor and now Senator Jim Mathias. She was probably best known for her tireless efforts in fighting the disease and spreading awareness in Ocean City and across the Lower Shore. She was the founder and first president of the Worcester County branch of the American Cancer Society and spent countless hours advocating and fundraising.
“All of the people in Kathy’s organizations, from the American Cancer Society to the Pink Ribbon ladies to her family and friends, are all so elated for the people this bill will help now,” Jim Mathias said. “This will provide effective, efficient and affordable chemotherapy for so many people and improve their quality of life. Kathy is still at work and her inspiration helped get this important bill passed.”
The legislation will 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 Kathleen A. Mathias Chemotherapy Parity Act of 2012 will 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 this week. “This bill will 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 in the past often covered 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 have been 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.
With the unanimous passage by both the House and the Senate, the bill needs only a signature from the governor, expected to a mere formality, before going into effect on Oct. 1. However, Mathias said last week the broad support for the bill could have a much shorter affect.
“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,” he said. “I think we will be able to make that case for those who need drugs now.”