The Leukemia & Lymphoma Society A powerhouse among nonprofits searching for cancer cures Our Mission: Cure leukemia, lymphoma, Hodgkin s disease and myeloma, and improve the quality of life of patients and their families Every four minutes, someone is diagnosed and every 10 minutes, someone dies more than 53,010 in 2011
What we do Provide Information Information Resource Center Answer questions and provide resources in more than 165 languages. Link patients to the most up-to-date clinical trials and community resources. Web site - www.lls.org National Education Webcasts and Telephone Workshops Educational materials
Giving Patients And Families What They Need, At No Cost Local Services Three Pennsylvania Chapters Western, Central & Eastern Last year in PA Over 3,400 first time inquires concerning our Patient Services Programs and requests for information by patients, family members, caregivers and healthcare professionals. Over 2,100 patients and caregivers attended various seminars throughout PA. Local physicians presented the latest information on the diseases, treatment advances and survivorship issues, allowing patients to become an active participant in their cancer journey.
Giving Patients And Families What They Need, At No Cost Local Services (cont.) Last year in PA Offered Support to All: More than 20 monthly LLS Family Support Groups for patients and family members were coordinated throughout the state. $283,000 in Patient Financial Aid to Local Patients: We help shoulder the burden of patient expenses and are one of the few non-profit organizations in the nation to do so. Co-Pay Assistance Program helps eligible patients cover prescription drug co-pays and health insurance premiums
LLS Advocates nationally and locally for legislation that will improve the quality of life of patients and their families LLS works to: Ensure effective, federally-funded biomedical research Enhance the quality of cancer care Educate and mobilize volunteers to take action Provide access to the myriad of treatments available LLS supports public policy initiatives federally and locally including Oral Parity Legislation in Pennsylvania
Patient Access: Issue Background Historically, oncology treatment has been administered intravenously (IV) in a physician s office. However, as innovation has continued to evolve, oral therapies represent an increasing number of prescribed oncolytics. Intravenous (IV) cancer medications are typically covered under a health plan s medical benefit. In this situation, patients are usually required to pay an office visit copayment and are not required to pay a separate fee for the drug.
Issue Background (cont d) Orally administered cancer medications are typically covered under a health plan s pharmacy benefit, and some plans require patients to pay high out of pocket co pays to fill these prescriptions (avg OOP in 2009: $2942, up 17% from 2008). Unfortunately, insurance benefit design has not kept up with medical innovation which has created a major barrier for patients that need access to life-saving treatments. It is estimated that 25-35% of the medications in the oncology development pipeline are oral therapies.
Issue Background (cont d) High out-of-pocket costs for treatment places financial hardships on many cancer patients. When confronted with this reality, some choose to forgo treatment or make their treatment choice based on cost rather efficacy A new study found that 10% of patients did NOT fill their initial prescriptions for oral anti-cancer medications due to high rates of cost-sharing There are no intravenous substitutes for many oral chemotherapy drugs. Patients affected by this issue include multiple myeloma, leukemia, lymphoma, breast, kidney, lung and brain cancer patients.
Common Myths Debunked Oral chemotherapy is more expensive than IV The number of visits for initial care follow-ups and potential complications is substantially fewer for oral chemotherapy than for IV chemotherapy. 10 % of the cost for IV chemotherapy drugs comes from administrative expenses including the nurse and doctor s time. Other issues to take into consideration: time off work to get infusions, possible temporary disability, long term medical cost associated with side effects of IV chemotherapy
Common Myths Debunked Mandate? This bill is NOT a mandate! It does NOT require health plans to cover chemotherapy. It simply says that if a plan covers cancer treatment, then it must cover oral and IV or injectibles at an equal reimbursement rate. Oral chemotherapy parity will increase premiums Studies conducted in states that have oral chemotherapy parity laws such as Vermont, Texas, and Indiana have concluded that any raises in health insurance premiums would be negligible
Conclusion Access to oral anti-cancer medications is - and will continue to be - a growing problem in the cancer community (and in other disease areas) until insurance benefit design is modernized to keep pace with medical innovation. Patients and their physicians should be able to make choices about treatment based on what is most therapeutic and what gives each patient the best chance of survival, NOT based on insurance coverage and reimbursement. Access to oral treatments is a life or death situation for many patients and we support any efforts to remove barriers to accessing the life-saving treatments that patients need.
FOR MORE INFORMATION Talk to our patient advocates in the audience today Arrange for a meeting to speak to our patients and LLS Staff Contact Info: Danielle Bubnis - Patient Services Manager, CPA Chapter 717.652.6520 ext. 1259 danielle.bubnis@lls.org Ilana Benyosef Patient Services Manager, EPA Chapter 610-238-0360 ext. 6781 ilana.benyosef@lls.org Francine Morrison - Patient Services Manager, WPA Chapter (412) 395-2873 francine.morrison@lls.org