From: BMT Newsletter, November 1994 Issue # 26 - BMTs for Acute Lymphocytic Leukemia. Reprinted by NYSERNet with Permission from BMT Newsletter
Effective immediately, the health insurance plans covering the nation's 10 million federal employees and their families will pay for high-dose chemotherapy and an autologous bone marrow transplant (ABMT) or a peripheral stem cell transplant (PSCT) to treat breast cancer, multiple myeloma, and epithelial ovarian cancer. The change in policy followed August hearings before the congressional Post Office Subcommittee at which breast cancer survivors, physicians and attorneys testified that the treatment should be covered by health insurance plans.
"With the addition of this coverage under the Federal Employee Health Benefit Program, the choice of appropriate treatment options will be back with the patient, doctor and insurance plan." - Jim King, a spokesman for the Office of Professional Management.
The effort to change federal policy on this issue was spearheaded by women Pat Schroeder (CO) and Eleanor Holmes-Norton (DC). Following the August hearings, a representative of the Office of Professional Management (OPM) the agency that defines health care benefits for federal employees - promised to reconsider their position on ABMTs for breast cancer, multiple myeloma and ovarian cancer. The change in federal policy was announced just 30 days later.
"The federal government and their insurers have finally acknowledged what has been obvious to doctor and scientists for years - that ABMT is a state-of-the-art treatment," said Arlene Groch, a New Jersey attorney who has successfully represented breast cancer patients in legal actions seeking insurance payment for their ABMT. "Ironically this change in policy was accompanied by a 3.4 percent reduction in insurance premiums, despite the federal government's prior claim that covering ABMTs would be too expensive."
Approximately 350 different health insurance plans cover federal employees. The majority are prepaid comprehensive medical plans (HMOs), seven are "fee for service" plans. Twenty-one percent of the HMOs will limit coverage to clinical trials, including trials not sponsored or funded by the National Cancer Institute (NCI). Employees enrolled in the Blue Cross/Blue Shield fee-for-service plan will be covered only if the ABMT is performed as part of an NCI-sponsored clinical trial. If, however, no NCI clinical trial is available, the treatment will be covered at the same level as any other transplant.
The American Postal Workers Union Health Plan, the Postmasters Benefit Plan, the Alliance Health Benefit Plan, and the Government Employees Hospital Association (GEHA) Benefit Plan will limit coverage to $100,000 per transplant. The Mail Handlers Benefit Plan will limit coverage to $300,000 per transplant.
"With the addition of this coverage under the Federal Employee Health Benefit Program, the choice of appropriate treatment options will be back with the patient, doctor and insurance plan," said Jim King, a spokesman for the Office of Professional Management. "It simply was time to move the decision from the hearing room to the hospital room."
The electronic version of this document was created by NYSERNet, Inc. through a grant funded by the New York State Science and Technology Foundation as part of the Breast Cancer Information Clearinghouse.