Insurance Companies Leery of Cancer Bill

Last updated on May 13th, 2019 at 02:35 pm

Two Republican lawmakers plan to introduce the Cancer Patient Protection Bill this fall, which would require insurance companies to cover routine care for cancer patients entering clinical trials.

The intent of the bill is to make coverage for patients in clinical trials uniform, said State Rep. Scott Gunderson (R-Waterford), who is planning to introduce the bill with State Sen. Cathy Stepp (R-Sturtevant).

Currently, some patients are covered in clinical trials, while others are not, depending on their insurance carriers, Gunderson said.

"If someone has cancer and they elect to enter a (clinical) trial, they should be able to maintain some level of coverage," he said. "It seems odd to me that someone’s unfortunate enough to get cancer, and their doctor says, ‘There’s a trial here, and I think you should give it a try,’ and all of a sudden there’s an insurance company that’s entering the picture and tells them they won’t cover their care. I don’t understand that, and I think that other people don’t understand that too."

Similar laws are currently on the books in 22 other states, said Dr. Jim Stewart, a medical oncologist at the University of Wisconsin Comprehensive Cancer Center in Madison.

"The intent of this is to create a level playing field for patients and insurers," he said. "For many years, cancer treatments have progressed in the right direction, but there are way too many patients who don’t have good treatments for their disease. The purpose of this bill is to not discriminate against patients who choose to participate in clinical trials."

Any patient who has advanced stage cancer or is not responding to traditional treatments should be encouraged to enter clinical trials, Stewart said.

"The problem for the average patient is that they don’t know where their insurance stands," he said. "My bottom line is that there should be uniformity in the state."

If approved, the legislation would mandate insurance to cover certain expenses, but it would not result in higher medical insurance costs in Wisconsin, both Gunderson and Stewart said.

"And if we have (more) people entering trials, we will find, No. 1, ways to keep them alive, and No. 2, better ways to treat people and save lives," Gunderson said.

Gunderson and Stepp will formally introduce the bill later this month. It will then go to committee, and could be on the Assembly floor as early as October, Gunderson said. The measure has gathered a fair number of co-sponsors, both Democratic and Republican, he said.

"I think that’s because they think this is just the right thing to do," Gunderson said.

The American Cancer Society supports the bill because it does not discourage patients from entering clinical trials, said Russ Hinz, chief operating officer of the Midwest division of the American Cancer Society.

"The critical thing that has to happen to eliminate cancer is increasing access to clinical trials and making sure the research engine is humming at full strength," Hinz said. "We need to have people entering in trials to lead to new discoveries. Yes, it’s a mandate. But the more discovery we have and the faster we can deal with the disease, the faster costs will go down because of excellent research."

Phil Dougherty, deputy director of the Wisconsin Association of Health Plans (WAHP), a trade association that represents the interests of more than 20 HMOs operating in the state, said his group has had some early talks with Gunderson, Stepp and officials of the UW Medical System. Those talks have not been completed, Dougherty said, and the association has not yet formed an official stance on the proposal.

Because the agency has not taken an official stance, Dougherty declined to comment specifically on the Cancer Patient Protection Bill. However, he did say that WAHP has historically been opposed to health care mandates because of their effects on costs.

"Mandates require coverage and increased costs in the market and can affect utilization, at a time when many employers can’t afford to self-fund their programs," Dougherty said. "Those who are forced to get their benefits in the market are forced to provide and pay for these benefits mandated by the state at a time they are also struggling to afford basic levels of care. Market forces should determine what should be provided."

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