MADISON (AP) – Republicans pushed a plan through the Wisconsin Assembly early Friday to include a $100 monthly copay cap for cancer patients buying chemotherapy drugs in pill form, a change that Democrats say could put the entire bill – intended to make the drugs more affordable – at risk in the Senate.
The Senate overwhelmingly approved a version without the cap earlier this week. But Republicans in the Assembly argued that a copay cap was needed to prevent the costs from being even higher.
Democrats, who unsuccessfully tried to block the amendment, said the cap could allow insurance companies to charge a higher copay because the bill already states that the copay applied to pills be the same as intravenous treatments. IV treatments as a hospital or doctor’s office often cost only a $20 copay with insurance.
They also argued there was no need to change a bill that the Senate already passed and the governor has agreed to sign. The last chance for the bill to pass is April 1, the Senate’s only remaining session day.
“Why do you want to make it tougher for cancer patients in this state?” Democratic Minority Leader Peter Barca said during the late-night debate. “Why do you want to do less for cancer patients in this state?”
Rep. John Nygren, R-Marinette, argued that without the $100 copay limit, the cost for some patients could grow even higher without the cap.
Two Republicans, Reps. Andre Jacque of DePere and Dean Kaufert of Neenah, joined Democrats in trying to turn back the amendment, but their efforts failed on a 40-54 vote. All but 13 Democrats then joined Republicans in passing the bill 75-18. Thirteen Republicans voted against it.
The bill would require that health insurance companies charge the same for chemotherapy drugs in pill form, which can be taken at home, as they do for intravenous treatments. Unlike intravenous treatments, oral chemotherapy is considered a pharmacy benefit rather than an insurance-covered medical treatment, so the pills can cost thousands of dollars a month.
During the sometimes emotional debate, lawmakers recounted stories of battling cancer both personally and with family members and friends. Debate began late Thursday night and concluded around 1:30 a.m. Friday with bill sponsor, Majority Leader Pat Strachota, saying she “pledged my honor” that the bill would pass the Senate and be signed by Gov. Scott Walker.
Senate Republican Majority Leader Scott Fitzgerald had said he would be open to voting on the bill again, not knowing what changes the Assembly might make. Walker’s spokeswoman on Thursday said he would sign the bill. There was no immediate reaction from Walker or Senate Republican leaders after the Assembly vote.
The amendment isn’t the first snag the legislation has faced. Just days before the Assembly vote, it appeared as if the bill would not come up because Republican leaders used procedural moves to bottle it up, citing opposition from a handful of lawmakers.
But after the Senate approved the bill Tuesday, pressure mounted on the Assembly to vote on the plan by the end of Thursday’s session – the final day the Assembly was meeting this year. Speaker Robin Vos and Strachota announced the deal to include the $100 copay just before the session day began Thursday afternoon.
Insurance companies, which originally opposed the bill for fear it would raise costs, moved to being neutral with the amendment. Cancer support advocates joined with Vos at a news conference to announce their support for the bill with the copay.
Historically, intravenous treatments have been the predominant route for administering chemotherapy to fight a wide variety of cancers. While chemotherapy in pill form has been available for decades, supporters of the bill say more of the new drugs being developed are in pill form, not intravenous form.
But oral chemotherapy can cost thousands of dollars a month, while intravenous treatments at a hospital or doctor’s office often cost only a $20 copayment under a patient’s insurance policy.
Insurance companies typically view the oral drugs as a pharmacy benefit and the intravenous therapy as a medical treatment, which leads to the price disparity. Patients can often be required to pay half of the pharmacy benefit’s cost.
Strachota said the $100 copay is common in the 29 other states with similar laws and makes sense. The change won the support of groups that have been lobbying for passage of the bill for years.
If signed into law, the Wisconsin bill would take effect in January.