Bill would eliminate costly difference between oral, IV chemotherapy

Thomas Van Hoof learned about the nuances of how some health plans cover oral chemotherapy drugs the same way most people do: He was diagnosed with cancer.

The cancer was multiple myeloma, and the treatment includes Revlimid, a drug that costs roughly $120,000 a year.

Revlimid is given orally, not intravenously, and the difference meant that Van Hoof's health plan would cover only half the cost.

"I said, 'Huh? This is our coverage?' " Van Hoof recalled. "That's when the jaw drops to the floor. That's the shocker."

The health plan covered chemotherapy drugs administered intravenously in a hospital or clinic. But Revlimid, available only as a pill, was considered a prescription drug, and his health plan covered only half of the cost of prescription drugs.

"It doesn't make any sense," said Van Hoof, a self-employed architect and real estate developer who lives in Shorewood.

State Sen. Alberta Darling (R-River Hills) is pushing for legislation that would change that.

Darling introduced a bill last year that would require health plans regulated by the state to provide similar coverage for oral and intravenous chemotherapy drugs. State Rep. Pat Strachota (R-West Bend) is sponsoring the bill in the Assembly.

More than a quarter of the estimated 400 chemotherapy drugs in development are in oral form, according to advocates. And Darling said the way insurance covers the drugs will become a more significant issue in coming years.

"You can't read your tea leaves or palm and determine if you are going to get cancer," Darling said.

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