64-year-old Barbara Wagner, whose lung cancer had returned and was deemed terminal, had her claim for a $4,000 a month medication to extend her life denied by the state-run Oregon Health Plan while they approved palliative, or comfort, care only.
The rules governing Oregon Health Plan say that drugs must meet a 5% survival rate after five years to be covered by the plan. The prescribed drug, Erlotinib, has a median survival rate of 6.7 months in patients who had already completed chemo.
The Oregon Health Plan provides care to those whose incomes fall under the poverty level. Coverage is prioritized from prevention through chronic disease management, mental health then heart and finally cancer treatment.
Source:
abcnews.go.com