3 replies to this topic

[CallMeLucky]

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.

http://www.cga.ct.go...SB-00050-PA.htm

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.

[hannibellemo]

Lucky,

The sentence that you quoted from the law gave me pause. In the broadest sense of the word, as I understand it, TKIs may be considered "chemotherapy" because they are "drug treatments". However, in the strictest sense of the term they are 'targeted therapies", not chemotherapy in the same way that other leukemias are treated with "chemotherapy".

I would want broader or more specific language in the bill to eliminate all doubt that our TKIs would be covered.

Please correct me if I misread your post in any way.

Pat

[CallMeLucky]

I really have no idea, I just happen to stumble upon this and I found what I believe is a coy of the bill online.  I have to make some phone calls to find out more.  Not sure where to start, I assume I will contact the State Insurance board or something like that.

[CallMeLucky]

Found out some interesting stuff today.  I talked to state insurance department.  First thing they said was "what state is the company headquartered in".  I told him not CT, he said "then the law doesn't matter, it only applies to companies that are based in CT".  I told him I lived in CT and shouldn't the law protect me as a resident of the state, he said "no, it is a law that dictates what insurance contracts must do when issued with a company in CT.  I said "ok so I have to find out what the law is in the state where they are headquartered?".  He then asked what company it was, I told him, and he said "it doesn't matter what state they are headquartered in, they are self insured".  Now, I know what self insured is, but I wanted him to clarify.  He went on to say "most companies do not actually issue their employees insurance policies, that would require them to have various contracts with each state to comply with".  He went on to say "instead, they issue a group policy and hire a provider like United Health Care to administer the plan.  All claims are sent to the employer to be paid out of their pocket".  I was aware of this because I used to have a job where I was in treasury and paid the insurance bill each month, I remember asking the woman in HR why it fluctuated so much from month to month and she said it was because we were self insured.  I asked the insurance department what all this meant.  He said basically the law had no impact on them because there was no "insurance policy".  He said they are regulated by the department of labor and if I had questions I could ask them.

Here's some more info http://www.healthins...nfo/HISELFI.HTM