New Legislation Would Stop Medicaid From Limiting Access to Cancer Drugs
When most people receive a cancer diagnosis, they assume they will receive the best, most effective treatments available. Unfortunately for those who rely on Medicaid, most of whom are living below the federal poverty level, this may not be the case.
Sixty-six million individuals in the United States (approximately 2.6 million in Ohio) were enrolled in Medicaid as of March 2019. And 35 million individuals were enrolled in the Children’s Health Insurance Program (CHIP) or were children enrolled in the Medicaid program in the 48 states that reported child enrollment data for March 2019.
Forty percent have incomes below 100 percent of the federal poverty level. Fifty-nine percent have incomes below 138 percent of the federal poverty level. And most of these children and adults are in poor or fair health.
Another sad statistic: None of these children and adults are covered for participation in cancer clinical trials.
A new piece of legislation, The CLINICAL TREATMENT Act, H.R. 913, was introduced by Representatives Ben Ray Lujan (D-NM-03) and Gus Bilirakis (R-FL-12) to guarantee coverage of the routine care costs of clinical trial participation for Medicaid enrollees with a life-threatening condition.
“The most vulnerable in our country, and right here in our own neighborhoods, don’t have access to the newest, most promising cancer treatments in clinical trials because they are poor,” said David M. Waterhouse, MD, MPH, Oncologist, Hematologist, and Co-director of Research at OHC (Oncology Hematology Care), “and their health will potentially decrease because they cannot afford the costs related to new, effective treatments in clinical trials. For me, this is unacceptable.”
Currently, Medicaid is the only major payer not required to cover the routine care costs associated with clinical research trials. Medicare has paid for these services since 2000 and private payers are required to provide coverage under the provisions of the Public Health Service Act section 2709, enacted as part of the Affordable Care Act.
Medicaid serves a large portion of under-represented minorities and ethnicities that are not well represented in clinical trial enrollment. Failure to address the coverage barrier that Medicaid patients face could further exacerbate existing disparities and prevent researchers from obtaining optimal results in clinical trials.
“At OHC, we have patients whose cancer doesn’t always respond to the current evidence-based treatment, so we enroll them in clinical trials. And in so many cases, the response to the new drugs is remarkable,” Dr. Waterhouse explained. “For example, I always think of one patient of ours who had stage 4 lung cancer that had spread to his brain. We enrolled him in a clinical trial testing an immunotherapy drug. Six years later, not only is he surviving, he’s thriving! He’s enjoying life when in reality, he should have passed away six years ago. That’s the incredible potential power of a clinical trial, and everyone deserves that opportunity.”
Providing coverage for the routine costs of clinical trials is affordable for states, as several studies have demonstrated a minimal effect on overall care costs. In most cases, this is coverage for care that patients would be receiving anyway, such as physician visits and laboratory studies. The cost of the drug or device being studied would still be covered by the clinical trial sponsor, typically a drug or medical device company.
Guaranteed coverage of these costs would help ensure that cancer patients covered by Medicaid have access to potentially lifesaving clinical trials and will help to improve disparities in clinical trial participation.
OHC (Oncology Hematology Care) and the American Society of Clinical Oncology (ASCO) is asking you to urge your lawmakers to support H.R. 913 and eliminate this barrier to access for cancer patients. Click this link to reach your lawmaker: https://asco.quorum.us/campaign/14280/.
For more information on ASCO’s position on Medicaid coverage of clinical trials, please email firstname.lastname@example.org. To learn more about OHC’s nationally recognized clinical trial program, please visit here. OHC offers its patients the assistance of a financial navigator to help identify opportunities to cover costs associated with cancer care that are not covered by insurance, Medicare or for patients with limited income.
OHC (Oncology Hematology Care) has been fighting cancer on the front lines for more than three decades. We are the region’s leading experts in the treatment of nearly every form of adult cancer and complex blood disorder. OHC offers the latest medical, gynecologic and radiation therapy, and is always seeking better treatment options through participation in clinical trials. OHC is certified by the American Society for Clinical Oncology in the Quality Oncology Practice Initiative Certification Program, is an accredited Oncology Medical Home, and is one of only 176 practices nationally to be accepted into the Medicare Oncology Initiative. At its heart, our approach to cancer care is simple – to surround you with everything you need so you can focus on what matters most: beating cancer. For more information about services and careers at OHC, call 1-888-649-4800 or visit ohcare.com.
Sources: The American Society of Clinical Oncology, Centers for Medicare & Medicaid Services, The Ohio Department of Medicaid, The Medicaid and CHIP Payment and Access Commission (MACPAC)