Insurance and Real Estate Committee

JOINT FAVORABLE REPORT

Bill No.:

HB-6320

Title:

AN ACT CONCERNING HEALTH INSURANCE COVERAGE OF ORALLY AND INTRAVENOUSLY ADMINISTERED MEDICATIONS.

Vote Date:

2/14/2013

Vote Action:

Joint Favorable

PH Date:

2/5/2013

File No.:

SPONSORS OF BILL:

Insurance and Real Estate Committee

REASONS FOR BILL:

The bill will require insurance companies who already provide coverage for IV-administered medications for disabling or life-threatening chronic disease, to also cover those medications if they're available to be administered orally.

RESPONSE FROM ADMINISTRATION/AGENCY:

Michelle Noehren, Permanent Commission on the Status of Women testified in support of the bill, stating that “Thanks to advancements in modern medicine, some medications, including some forms of chemotherapy, can now be taken in the form of a pill or liquid instead of solely through an IV. While it's up to a doctor and patient to decide whether IV or oral medications make the most sense, there are benefits to being able to take medication by mouth. Those benefits include the ability to be in the comforts of one's own home instead of in a hospital setting or doctor's office and the avoidance of more evasive medical intervention such as chemotherapy ports.” She concluded by saying, “Providing doctors with more options for treatment benefits all Connecticut women, those soon to be diagnosed with cancer and those in the future.”

NATURE AND SOURCES OF SUPPORT:

Senator Martin Looney, 11th District testified in support of the bill, stating that it would “create greater equity in our health care system by extending to disabling or life-threatening chronic disease patients protections that we extended to cancer patients three years ago.” Senator Looney stated that Public Act 10-63, concerning oral chemotherapy treatments, addressed the fact that many current therapies can include oral rather than intravenous chemotherapy. He stated, “Unfortunately, this act applied only to cancer therapy. And there are a number of other diseases that are now best treated with these types of oral medications. However, these drugs tend to be extraordinarily expensive. Many of the drugs come in pill form and, thus, are covered as prescription drugs rather than as medical expenses. Many health plans would cover a hundred percent of an IV infusion but only a percentage of the prescription drug. This seems an absurd result since oral drugs would seem to save the health system time as well as money.” He concluding by stating that this bill will “create greater equity in our health care system by extending to disabling or life-threatening chronic disease patients protections that we extended to cancer patients three years ago.”

CT State Medical Society submitted written testimony in support of the bill, stating that “any service deemed medically necessary by a physician should be covered under insurance policies for the care and treatment of patients. Unfortunately the unwillingness of health insurers to routinely cover medically necessary services often leads to the need for legislation requiring coverage. This is such a situation.” They concluded their testimony by stating that the “determination of the best delivery mechanism either intravenously or orally should be made by the treating physician. Should oral medication be determined the most appropriate manner, coverage should be provided equally, ensuring the patient receives needed care.”

NATURE AND SOURCES OF OPPOSITION:

Christine Cappiello, Anthem Blue Cross and Blue Shield, submitted written testimony in opposition to the bill, stating that it would “impose a new mandate for all individual and group policies, potentially including the State Employee Health Insurance Plan. Mandates remove any choice that employers or individuals might have in purchasing health care. The cost of mandates may cause the purchasers of healthcare, specifically employers, to stop offering health insurance all together.” In conclusion, her testimony stated that this bill “raises patient safety concerns because the lack of an in-office treatment removes the physician's direct supervision which provides an opportunity for the physician to see side effects first hand and address them. Finally, this proposal does not take into consideration the structure of the health plan – which provides coverage for IV drugs as medical benefits and oral prescriptions as a pharmacy benefit – this may increase the member's out of pocket expense and offers no remedy if the member chooses not to have prescription drug coverage.”

Susan Halpin, the CT Association of Health Plans, testified in opposition to the bill, stating that as written the bill “is very vague, but it would appear to require that insurers cover intravenous and oral medications on an equal cost-sharing basis for all disabling or life-threatening diseases. So that could be a huge and wide-ranging number of drugs and pharmaceuticals that are included.” In addition she stated that intravenous medications often fall under the medical benefit portion of a policy while oral medications fall under the pharmacy benefit. She stated “If you look at the state account, for instance, which has separate carriers from medical and pharmacy benefits, each has its own structure and its own cost-sharing requirements.” She concluded by stating, “From the quality standpoint, there are studies that suggest that compliance and safety are often better when associated with IV therapies versus oral medications, and there may be important clinical reasons for incentivizing patients to use such services.”

Brian Quigley, Express Scripts, testified in opposition to the bill, stating “Such a broad-sweeping mandate beyond the existing oral chemo mandate creates great concern because there are a number of new oral medications, new biologic medications coming onto the market, single manufacturers or orphan drugs, whereas Senator Looney pointed out, the cost may be 30, 40, 50,000 dollars a year.” He stated that it is a problem for pharmacy benefit managers and insurers that a single manufacturer of a new drug can set the market without negotiation and as a result “the health plans and our employer customers look to the PBNs to try to find a way to control the cost of that.” He concluded by stating “With very broadly-defined terms [of what types of medications are included in the benefit], it could create a very significant expense. And like all mandates, this will not apply to self-funded businesses. So the primary burden of the cost of this benefit and any selection against carriers will be on small employers.”

Jennifer Herz, CBIA submitted written testimony in opposition to the bill, stating that CBIA “strongly encourages rejection of new benefit mandates including [those in this bill].”

Reported by: Sheila McCreven

Date: February 22, 2013