You would think in this era of the COVID-19 pandemic, health insurance companies would exercise responsibility and be hyper-sensitive to at-risk patients, those with co-morbidities and especially those being treated for cancer.
But that is clearly not the case with Blue Cross Blue Shield in North Carolina. In a recent notice to policy holders, effective July 1, 2020, Blue Cross Blue Shield will no longer cover the cost of white blood cell growth factors, which are administered in conjunction with chemotherapy treatments, unless “the patient has a documented life-threatening side effect that required medical intervention.”
As a survivor who has had two tours of duty on aggressive chemotherapy for triple-negative breast cancer, let me break down to you what this really means for cancer patients.
Chemotherapy kills cells throughout your body, significantly weakens your immune system and puts the patient at high risk for viral and bacterial infections. When I was on chemo, my oncologist highly recommended I wear a mask in public settings, avoid close contact with people and wash my hands frequently to avoid germs that could cause an infection and put my life at risk. Sounds similar to COVID-19 restrictions, right?
Additionally, I was given an essential medication immediately after chemo to enhance my white blood cell growth (white blood cells fight infections) so my body could rebuild my immune system more rapidly and help me recover safely prior to my next chemo infusion.
That white blood cell growth medication must be administered exactly 24 hours after chemotherapy and is most effectively delivered as an on-body injector that is administered while a patient is at their chemotherapy session. The medication, Neulasta Onpro, is necessary to decrease the incidence of infection. Neulasta Onpro is clearly the drug of choice for immune system protection after chemotherapy, as 95 percent of both patients and nurses choose it again.
All this to say that this essential medication is no longer covered by Blue Cross Blue Shield in the state of North Carolina. The impact of this is significant:
- The patient (now with a very compromised immune system) would have to come back to the germ-infected, COVID-prevalent hospital 24 hours after chemotherapy, putting them at severe risk as they potentially take public transportation and sit in a compromising hospital waiting room.
- If the patient travels back to the hospital for the shot, they may be further exposed to COVID-19 and could then spread the virus to their family members.
- An immune-compromised patient with lower income may opt not to come back for this life-saving medication if they can’t afford the additional cost of transportation back to the hospital.
- The immune-compromised patient may have to pay for the drug out of pocket, since it will be administered at home.
- Lastly, the immune-compromised cancer patient may have co-morbidities, like high blood pressure (40 percent of black women do) and diabetes (1 in 4 black women 55 years and older have it), elevating the risk for getting COVID-19.
At a time when most medical professionals, health-care providers, policy makers, corporations, industry leaders and even the government are working diligently to keep people safe, it is shocking to think a company as large as Blue Cross Blue Shield would put patients at risk in this unnecessary manner. If the issue is to reap a cost savings, it seems counter-intuitive, as it would be more costly if and when patients are exposed to and contract COVID, get hospitalized, are subsequently put on ventilators and use a lot more resources. And how about considering those that will die as a result of this decision—both patients and exposed family members?
“The early population data already shows that up to 50 percent of cancer patients and survivors have had some impact to their health care due to the coronavirus. They are struggling with changes in their treatment, financial woes, including loss of wages and health insurance, compounded by fears about interruptions in continuity of the life-saving care they need, making it a moral imperative that we not sit by idly and allow cancer treatment to be placed on the back burner,” said Monique Gary, M.D., a breast surgical oncologist and health disparities advocate. “The novel coronavirus has had a major and disproportionate impact on African Americans, especially any compromised immunity during this pandemic increases the risk for mortality in this vulnerable population. We need every resource in our armamentarium available for our patients.”
The mortality rate for breast cancer in black women in North Carolina is 43 percent higher than in white women. More than 200,000 black women in that state get breast cancer each year. With this new ruling in place, the mortality rate will escalate. Is that what you want to have happen Blue Cross Blue Shield? Is North Carolina your starting point to going nationwide with this? And to the health professionals in North Carolina, are you just going to do nothing and let this happen? Does black health really matter? Do black lives really matter?
Apparently not in North Carolina.
“We live in an unprecedented time in the history of our country where it is evident that the color of people’s skin affects health outcomes,” said Maimah Karmo, founder, president and CEO of Tigerlily Foundation. “Outdated systems and systemic change must be made in order to prioritize how black women’s lives are being impacted. Blue Cross Blue Shield is in a position to join other leaders in ensuring their policies promote health equity for a population most adversely affected.”
On my path to live my purpose to eradicate #BlackBreastCancer, I will continue to look at all practices and policies that impact our health. I encourage all to do the same. Unfortunately, where you live still impacts whether you live. If you live in North Carolina and have breast cancer, make sure you get health insurance that will cover all of your needs. If you live in North Carolina and don’t have breast cancer, check your policy just in case. Don’t put yourself in an at-risk position.
I live in Maryland and pay an exorbitant $860 a month for CareFirst (Blue Cross Blue Shield) health insurance. For the record, I did check my policy to see if this ruling will impact me. As a black woman, I do have a 39 percent chance of recurrence. When I called CareFirst to ask about my coverage, I was told that with a special request from my oncologist and approval from the CareFirst Specialty Team, I “should be” covered for Neulasta Onpro should I need chemotherapy again. That doesn’t sound convincing, but it’s not unexpected that we will always have to advocate for ourselves for the best treatment. I do have great concern for my breasties in North Carolina and pray that Blue Cross Blue Shield reverses this life-threatening decision and does not implement this policy in other states.
—Ricki Fairley
