Clarification needed to end “denial, delay and death” as insurers evade requirements
LANSING, Mich. (March 5, 2024) — Sen. Jeff Irwin (D-Ann Arbor) introduced a bill today that would clarify the scope of Michigan’s cancer treatment coverage law. Senate Bill 738 explicitly includes genetic therapy and immunotherapy such as chimeric antigen receptors T-cells (CAR-T) in the drugs insurers must cover. Michigan law already requires insurers to cover Food and Drug Administration (FDA)-approved anti-cancer drugs, but at least one major insurer has denied coverage for CAR-T, arguing that a genetic therapy was not a drug.
“The law needs to be clear so that insurers can’t find an excuse to delay or deny coverage for modern cancer therapies,” Sen. Irwin said. “In cancer treatment, delay can mean death. Senate Bill 738 will remove even the appearance that there is a loophole by unambiguously stating that genetic and immunotherapy cancer drugs must be covered.”
CAR-T is an FDA-approved form of immunotherapy that improves the ability of human T-cells to attack cancer. It is the standard of care for certain forms of lymphoma and other blood cancers. In 2020, Forrest VanPatten, a resident of Sparta, died of B-cell lymphoma after Priority Health denied coverage for CAR-T. VanPatten appealed the coverage denial but died before the final review was completed.
After VanPatten’s situation became public, the Department of Insurance and Financial Services issued a bulletin reminding insurers that they must cover anti-cancer genetic therapies and immunotherapies, including CAR-T, as part of the existing requirement to cover FDA-approved cancer treatment drugs. Sen. Irwin’s legislation would provide further clarity and strengthen Michigan’s law to make sure tragic, treatable situations like VanPatten’s never happen again.
“Insurers have always had an incentive to save money by stalling and denying cancer treatment coverage at the expense of people’s lives,” Sen. Irwin said. “That’s why the Legislature first passed this law in 1989 — to require insurers to cover FDA-approved cancer drugs without endless quibbles about interpretation. Senate Bill 738 will codify and reinforce the stated policy of the Department of Insurance and Financial Services that these FDA-approved immunotherapies must be covered.”
###