Cancer Insurance Cost Issues
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Paying for Cancer

Even for those with health insurance, the cost of cancer care can be overwhelming.


By Lisa Seachrist Chiu

Facing the Financial Realities of Cancer

Get prepared for the costs of your care

By Lisa Seachrist Chiu

When Oregon farmer Chuck Stauffer was diagnosed with a brain tumor in December 2005, his doctor recommended a delicate surgery to remove the tumor and then an ongoing course of the chemotherapy drug temozolomide (Temodar). Like many new chemotherapy agents, temozolomide has the benefit of being an oral pill a patient can take at home. The only problem is that while Stauffer’s health insurance would have completely covered a course of intravenous chemotherapy delivered at a doctor’s office or hospital, it required a 50 percent co-pay for the cost of oral chemotherapies. For his therapy, he needed to fill a prescription for temozolomide that cost him $1,715 every 23 days.

It turns out, as Stauffer and his family soon learned, that intravenous chemotherapy is usually covered under the medical benefit in insurance plans. As a result, once a patient has fulfilled his or her deductible, the insurance provider covers either most or all of the costs of IV chemotherapy. Oral chemotherapies, on the other hand, are typically treated as prescription drugs and fall under the prescription benefit. This leaves patients responsible for often-staggering co-pays with each course of chemotherapy.

“Insurance policies without question have failed to keep up with advances in cancer therapy,” says Kim Thiboldeaux, the president and chief executive officer of the Wellness Community, a cancer patient support and advocacy organization. “And that has resulted in a sometimes devastating financial burden for cancer patients and their families.”

The often-shocking cost of new therapies, like temozolomide, is just one factor contributing to the overwhelming financial burden facing many U.S. cancer patients—a problem that’s increasingly being recognized as a growing crisis. Just this June, a report from Harvard Law School, Harvard Medical School and Ohio University documented that more than 60 percent of all personal bankruptcies in the United States are the result of medical debt. What’s more, more than 75 percent of these bankrupt families had health insurance. It just wasn’t enough.

While the researchers didn’t analyze their data by type of diagnosis, Thiboldeaux notes that cancer has historically been an expensive disease that too often places patients and their families on the precipice of financial ruin. “We are increasingly getting phone calls from people who are truly in distress,” she says. “People with health insurance are really surprised by the out-of-pocket cost that comes with a cancer diagnosis. And, the economic downturn has only exacerbated the problem.”

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