Patient concern fuels fight for coverage of anticancer pills in Pa.


York County residents Teresa Helfrich and Denny Falvey died from cancer days apart in 2009, and their children now advocate for cancer patients in honor of their deceased parents.

One measure they're pushing in the state Legislature, House Bill 60, would provide more insurance coverage for oral anticancer pills, making them affordable for patients, Matt Helfrich said.

His mother was able to afford — because of a settlement from a medical suit — more than $1,000 a month for the pills.

She didn't lose her hair, vomit or lose energy, and she outlived her thyroid cancer prognosis by 11 years, said Helfrich, a 1994 York Catholic High School graduate who now lives in Montgomery County.

He credits part of those 11 years to the fact that her treatment was better than that which some other people could have afforded.

The fight: Helfrich, 39, said he's been in touch with state senators and representatives to push the bill.

"Everyone supports it, but no one's telling us why it's getting delayed," he said. "There's people dying or going into debt because they can't pay for this medicine."

Helfrich has worked with Sarah Falvey, a fellow York Catholic grad living in Baltimore, to raise more than $11,400 for the American Cancer Society through a charity golf outing, set for Oct. 2 at Heritage Hills Golf Course.

Oral chemotherapy wasn't an option for Falvey's father, who was diagnosed with stage-four prostate cancer in 2000, but Falvey said hope for others is her motivation.

"You just want the people to get the best care out there without having to worry about the expense for it," the 38-year-old said.

Expensive: Depending on the disease, cancer patients can receive either oral or IV chemo, and doctors often recommend a combination, said Dr. Robert Rice, a medical oncologist with WellSpan Medical Oncology.

The main difference between the two is the mode of administration, and side effects depend on the pill, he said.

Most IV meds are covered under a medical benefit and require a flat fee or come out of one's deductible, Rice said. Conversely, depending on a patient's insurance, oral chemo pills are often treated as a pharmacy benefit — and up to 25 percent of the cost can come out of a patient's pocket, he said.

"Cost is a big concern, because people live on a budget, and some of these drugs are very expensive," he said.

For instance, taking a $90 pill four times a day would come out to almost $3,000 (or 25 percent of the overall cost) a month, "which a lot of people can't afford," he said.

"The bill is a step in the right direction, but where is that cost gonna go? Because someone's got to pay for it. And that's the bigger question," he said.

Plenty of time?: State Sen. Pat Vance, a Republican who represents northern York County, said the bill's fate is up to the Senate's Banking and Insurance Committee, where it has been sitting since the end of February, when it passed the House 197-3. All of York County's legislators voted in favor.

Oral treatments have obvious advantages over IV because of their effectiveness and convenience, she said.

"Basically, as I see it, the drug companies are saying one thing, the insurers are saying another, and the patients are caught in the middle," she said.

Vance said she believes that the drug and insurance companies should share the blame — and because this is only the beginning of the legislative session, there's plenty of time left to move the bill.

However, cancer patients don't believe there's plenty of time, she said.

Other states: Insurance parity for these pills has been a multi-year effort, and the measure took a similar path at the end of last session, said Danielle Bubnis, senior advocacy manager of the Pennsylvania Cancer Treatment Fairness Coalition.

"We're hoping that we can see some movement in the near future," she said.

So far, 39 other states have enacted similar legislation, and Bubnis said she's working to show the state's strong insurance industry that the measure hasn't raised costs and negatively impacted policyholders in other states.

"It's not a novel piece of legislation," she said. "It's not a new issue."

— Reach Mollie Durkin