Limits to anti-nausea pill coverage wear on cancer patients and doctors
Some cancer patients are hitting coverage limits on a cheap anti-nausea pill that can ward off waves of vomiting after treatment
Cancer patients can ward off waves of vomiting after treatment with a relatively cheap anti-nausea pill, but some are running into coverage limits.
Doctors say restrictions on the number of tablets patients receive can hurt care. Pharmacy benefit managers say their limits guard against overuse, and they offer workarounds to get more tablets.
In between sit patients, who might ration pills or opt for less effective help for a dreaded side effect of radiation or chemotherapy.
The conflict shows how an array of coverages and poor communication can complicate even simple acts of care in the fragmented U.S. health care system.
“This is sort of the dirty underbelly of the current health care environment,” said oncologist Dr. Fumiko Chino. “Insurance companies and pharmacy benefit managers are somehow weirdly ending up in my exam room, standing between me and my patients.”
Steven Manetta takes at least a half dozen pills daily to help keep a form of leukemia in remission. For more than a year, he rationed his go-to anti-nausea pill, ondansetron, known by the brand-name Zofran.
Manetta’s coverage through CVS Caremark paid for 18 ondansetron pills every 21 days. That forced him to sometimes use alternatives that make him extremely drowsy in order to stretch his supply. He only recently got approval for a 90-day supply.
“It’s just like an extra thing to think about all the time,” the 33-year-old Lemont, Illinois, resident said. “When you’re on so many medications, the ones with the least side effects are the ones you always want to reach for.”
Ondansetron hit the U.S. market more than 30 years ago. It
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