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IMF supports legislation to require equitable insurance reimbursement for oral cancer drugs

Currently, provisions in many policies require a much greater co-payment from patients for oral drugs. On behalf of patients and caregivers, the IMF supports steps to mandate equitable coverage for patients based on therapeutic benefit, not based on how the drug is administered.

Olympia, WA and North Hollywood, CA, June 28, 2010 – The International Myeloma Foundation (IMF), the oldest and largest foundation dedicated to improving the life and care of myeloma patients, supports legislation being considered in Washington (Senate Bill 5512) and other states that will require private insurance companies to cover oral anti-cancer drugs at comparable rates to coverage for intravenous infusions and other procedures. Currently, provisions in many policies require a much greater co-payment from patients for oral drugs. On behalf of patients and caregivers, the IMF supports steps to mandate equitable coverage for patients based on therapeutic benefit, not based on how the drug is administered.

"New therapies, both oral and intravenous, have made a dramatic difference in advancing the treatment of multiple myeloma, yet they are not reimbursed at the same rates," said Susie Novis, president and co-founder of the IMF. "This means many patients have had to forego getting the drug that’s optimal for their treatment, or they’ve had to go into debt to meet the co-payments required. We question a system that reimburses the least for the most cost-effective treatments."

"We’re actively working this issue in Washington because we think there might be real benefits to patients," said Spokane Sen. Chris Marr, who sponsored Senate Bill 5512. "At the end of the day this is about making the best treatments more available to those who need them."

Vicki Jones, co-founder and leader of the Spokane Multiple Myeloma Support Network and a six-year myeloma survivor, testified before the Washington Department of Health at a hearing to determine the financial impact of legislation to require equitable insurance coverage. Ms. Jones, who works full-time and enjoys a good quality of life with new myeloma drugs, maintains her health insurance coverage through a private insurer.

Ms. Jones said, "I cannot emphasize enough how disheartening it was to learn that because of the way insurance reimburses, I could not get the oral medicine my doctor prescribed for my myeloma at an affordable rate. I had been dutifully paying for good insurance coverage – I thought I would have affordable access to whatever treatment I needed."

For now, Ms. Jones is receiving the IV treatments that she can afford because they do not require such a high co-payment, but as a myeloma patient, she expects to need oral drugs because treatments lose efficacy over time. She says insurance coverage should allow patients and their doctors to design the most effective treatment plans without being limited by the way the therapy is administered.

"The IMF believes patients should be able to take advantage of the treatment that is best for them and not have to select their treatment based on insurance coverage," said Brian G.M. Durie, M.D., chairman and co-founder of the IMF. "As a practicing hematologist-oncologist, I need the freedom to prescribe therapies based on their potential efficacy. Something is very wrong when the largest side effect is economic, based upon inequitable and irrational differences in reimbursement."

Multiple myeloma is a cancer of cells in the bone marrow. Once a rare disease of the elderly, multiple myeloma is being diagnosed in growing numbers and in increasingly younger people. Each year approximately 20,000 new cases are diagnosed in the United States. New treatments have extended remissions for many patients, measured in years, not months, with a good quality of life.

The International Myeloma Foundation is the oldest and largest myeloma organization, reaching more than 195,000 members in 113 countries worldwide. A 501 (c) 3 non-profit organization dedicated to improving the quality of life of myeloma patients and their families, the IMF focuses in four key areas: research, education, support, and advocacy. To date, the IMF has conducted more than 200 educational seminars worldwide, maintains a world-renowned hotline, and operates Bank on a Cure®, a unique gene bank to advance myeloma research. The IMF can be reached at (800) 452-CURE. The global website is www.myeloma.org.

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