You would think that 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. Well 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 that 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? Well, 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®
(pegfilgrastim) is necessary to decrease the incidence of infection.
All this to say that this medication Neulasta® Onpro® is no longer covered in North Carolina by Blue Cross Blue Shield. The impact of this is significant as follows:
- 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 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% of Black women have it) and diabetes (1 in 4 black women 55 years and older have it), the risk for getting COVID-19 is elevated.
At a time when most medical professionals, healthcare providers, policy-makers, corporations, industry leaders and even the government are working diligently to keep people safe, it is shocking to think that 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, be 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?
Dr. Monique Gary, breast surgical oncologist and health disparities advocate notes that “The early population data already shows that up to 50% 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. The novel coronavirus has had a major and disproportionate impact on African Americans, especially, and 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% higher than white women. More than 200,000 Black women in the 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 doing this nationwide? 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 Matter? Apparently not in North Carolina.
Maimah Karmo, Founder, President, CEO of Tigerlily Foundation says, “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. 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 that their policies promote health equity for a population who is 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 per month for Care First (Blue Cross Blue Shield) health insurance. For the record, I did check my policy to see if this ruling will impact me. Being a Black woman, I do have a 39% 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 (Blue Cross Blue Shield) 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 to other states.