So I read a post on Facebook by another CML member who is being an activist for a bill they are trying to pass in NY to require insurance companies to treat oral chemotherapy the same as IV chemotherapy administered by a physician. In simple terms, this means insurance companies wouldn't be able to put Gleevec under prescription plans, but would have to cover it under the regular insurance plan. This could have significant cost impact to the patient as the prescription plans are usually less favorable. I'm watching closely to see how this turns out. Then it got me thinking that I may have to move back to NY someday if I ever find myself in a situation where it would be more beneficial to have this kind of coverage. I live in CT now and was wondering what it would take to lobby gov't to pass such a bill like they are trying to do NY. As it turns out, CT already passed this law and made it effective Jan 1, 2011.
I'm still paying for my Gleevec via prescription plan. Now I really have nothing to complain about since I pay a very reasonable co-pay each month for my prescription. Still, under the terms of my health plan, I have already reached the annual out of pocket expense and technically, if I understnad this law correctly and my Gleevec were to be covered under my health plan instead of my prescription plan, then I actually shouldn't have to pay anything at all. Again, I happen to be very fortunate right now with my coverage, so I don't know that I would make a big deal to change this (I don't like being the squeeky wheel, that's a good way to get on people's radars). Nonetheless, this could have impact for me in the future (as well as others) should my coverage or job change. I have to figure out who to contact in gov't to find out the details and understand if I did want to push the issue, should my coverage be handled in a different way than it is today. I know there could be some contention if TKI drug is "chemotherapy" but in some of the documents I read, they made specific reference to Gleevec and the law makes specific reference to leukemia; "shall provide coverage under such policies for the surgical removal of tumors and treatment of leukemia, including outpatient chemotherapy" If that doesn't describe TKI drugs, I can't imagine why.
Hopefully this is really the case, in which case, it is nice to see the law is catching up.