New Law Requires Insurance Companies to Cover Medically Appropriate Drugs for Metastatic Cancer Patients

DOVER – Delawareans diagnosed with advanced, metastatic cancer will no longer be forced to first fail a series of treatments before getting approved for cutting-edge therapies under a new law sponsored by House Majority Leader Valerie Longhurst and Speaker Pete Schwartzkopf and signed by Governor John Carney on Wednesday.

Insurance companies have the ability to set coverage guidelines that govern how and when treatments are approved. However, sometimes those guidelines require patients to prove that they failed to respond to initial treatments before they can try advanced therapies.  

Under House Bill 120, insurance companies offering health plans that cover treatments for advanced, metastatic cancer or other forms of cancer where the drug is supported by national guidelines or standards would not be able to limit or exclude treatments for patients if the treatments have been approved by the U.S. Food and Drug Administration and are consistent with best practices for cancer treatment.

It’s critical to improve access to the most innovative treatments for metastatic patients in their time of need, Rep. Longhurst said, adding that these patients cannot afford to delay their care.

“I’ll never forget when my grandmother was diagnosed with a brain tumor. I was three months pregnant with my son when doctors gave her six months to live,” said Rep. Longhurst, D-Bear. “After my son was born she was able to hold him, but she passed away shortly thereafter. I would have loved for her to have a glimmer of hope, and the chance to try cutting-edge treatments. I know she would want me to work so that future patients have that opportunity and have access to therapies they deserve.

“That is what this bill represents to cancer patients throughout Delaware: hope. With more rapid access to potentially lifesaving treatment, there is hope that more patients will be able to recover and lead long, healthy lives. We know that one size does not fit all with cancer treatment, and this new law will help patients receive the individualized treatment they need quickly.”

Cancer rates have persisted; the American Cancer Society estimates that in 2017 there will be more than 1.6 million new cancer cases diagnosed in the United States and 600,000 deaths.

In Delaware, the estimated number of cancer cases to be diagnosed in 2017 will exceed 5,600. State health officials say that Delaware women still have the ninth-highest cancer death rate in the country.

Rep. Schwartzkopf also knows firsthand how a malignant melanoma diagnosis can change someone’s life. The former lifeguard had found a strange spot on his back – right along his spine – that eventually was diagnosed as spindle cell desmoplastic melanoma.

“When I was diagnosed with melanoma, my doctor told me that if the cancer had spread to my bloodstream I would have two months to live,” said Rep. Schwartzkopf, D-Rehoboth Beach. “After a painstakingly long week of waiting for test results, I was relieved to learn the cancer had not spread.

“I feel thankful that doctors were able to catch my cancer early and I was able to get the appropriate treatment and I want the same for patients diagnosed today. With this new law, patients and their families will have the opportunity to receive the treatment they need and not need to fail once, twice or three times before they can utilize a ‘wonder drug.’ ”

HB 120, the Jimmy Carter Cancer Bill, was inspired by President Carter, who was deemed cancer-free after an immunotherapy called Keytruda shrunk his metastatic melanoma tumors.

Immunotherapy is one of the most promising new cancer treatments, according to the Cancer Research Institute. These therapies activate a patient’s immune system to fight cancer instead of directly destroying cancer cells like chemotherapy treatments.

“Whether your cancer is detected early or found at an advanced stage, your treatment is a race against time,” said Senate President Pro Tempore David McBride, D-Hawk’s Nest, a prime sponsor of HB 120. “Thankfully, modern medicine gives us cause for hope: cutting edge pharmaceuticals have advanced enough that Stage 4 cancer can, in some cases, be treated and even brought into remission, as it was with President Carter. Knowing that, it’s unfair to force a cancer patient to waste precious time on trial-and-error before an insurance company agrees to cover treatment that could save their life. This legislation cuts through that red tape, sparing people incredible pain and suffering – or, for that matter, their lives.”

Similar legislation recently passed overwhelmingly in Georgia, and measures have been introduced in Connecticut and Maryland.

“We are grateful to Governor John Carney, to Rep. Valerie Longhurst, Speaker of the House Pete Schwartzkopf, and to Sen. David McBride and the many other lawmakers who have passed this important piece of legislation,” said Dr. Nicholas Petrelli, medical director of the Helen F. Graham Cancer Center & Research Institute. “A culture of innovation guides the care that we provide at our cancer center and this law helps ensure that our patients will have access to the innovative treatments that can help them achieve optimal health.”

“The Leukemia Research Foundation of Delaware provides critical funding to researchers who are continually developing specific, state of the art, targeted therapies,” said Denni Ferrara, president of the Leukemia Research Foundation of Delaware. “As a direct result of research dollars, new scientific discoveries are allowing doctors to provide a more precise treatment for all types of cancer. This bill helps to ensure that patients have access to the best and most advanced therapies.”