Alex Van Dyke, 17, who was 13 when he was diagnosed with cancer, has made a full recovery. But his mother, Audrey, never understood why his chemotherapy was covered while he was in a hospital or clinic but cost additional money when taken as a pill at home. The proposal that would require plans to cover the pills has supporters but likely won’t get a vote. Credit: MARK HOFFMAN

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Madison — The leader of the state Senate is going to unusual lengths to block a bipartisan bill to help cancer patients afford life-saving treatments as his brother lobbies on behalf of insurers to kill the proposal.

The proposal would require health plans to provide the same coverage for chemotherapy drugs taken as pills as they do for chemotherapy administered through IVs.

Audrey Van Dyke, whose 17-year-old son Alexander was diagnosed with cancer in 2010, has never understood why his chemotherapy was covered when he was in a hospital or clinic but cost additional money when taken as a pill at home.

"It doesn't make sense," Van Dyke said. "The drugs would have been covered if we lived across the border."

Twenty-nine states — including neighboring Iowa, Illinois and Minnesota — have passed laws requiring insurance companies to treat oral chemotherapy drugs the same as they do other chemotherapy,with little or no effect on premium costs. A bill to do that in Wisconsin has more than 50 co-sponsors, including many top Republicans: Assembly Majority Leader Pat Strachota, Sen. Alberta Darling, co-chair of the powerful budget committee, and Senate President Mike Ellis.

But Senate Majority Leader Scott Fitzgerald (R-Juneau) used a phantom committee meeting Wednesday to keep colleagues from voting on the bill, which he acknowledges will pass if it reaches the Senate floor. He said Thursday that he won't allow the bill to come forward in the Senate on Tuesday, leaving only an outside chance for the proposal to become law.

As Fitzgerald tries to block or rewrite the proposal, his brother, Jeff Fitzgerald, a lobbyist and former legislative leader himself, is working for the insurance companies that oppose the bill.

"Knowing Scott the way I do, I highly doubt that comes into play," said Democratic Sen. Jon Erpenbach of Middleton, the most outspoken critic of Fitzgerald's actions. "But I do clearly understand what the perception is going to be to everybody else in the state and the perception is not going to be good."

Health plans typically cover oral chemotherapy drugs under prescription drug plans that can have high co-pays, and for some health plans, those co-pays could run into tens of thousands of dollars a year. In contrast, when chemotherapy is administered at a hospital or clinic, it is covered as part of a health plan's standard medical coverage with no additional cost once the deductible is reached.

For his part, Scott Fitzgerald said GOP senators would discuss the bill next week and that he hoped "we can arrive at a version of the bill that our members can agree on."

But he also said the Senate won't take up the bill on Tuesday, which likely kills it. The Assembly's last planned session is Thursday, so the bill is effectively dead if it doesn't pass that house by then.

In the Assembly, the chemotherapy bill hasn't even passed out of the health committee and Assembly Speaker Robin Vos (R-Rochester) is signaling that he opposes it.

"In the past, I have not voted for any mandates," he said.

Strachota, who is not running for re-election, has a high position in the Assembly and passion for the bill, which is the last major proposal that she could push through before retiring. But she made clear that the bill was unlikely to pass in her house first, if it passes there at all.

"There's always hope," she said. "I know that there's still talk in the Senate."

Cancer survivor Jim Logan of Glendale can't believe the bill isn't passing.

"Whether it's IV or a pill, it's chemotherapy," he said. "There shouldn't even be a question about it."

Logan, who was diagnosed with chronic myelogenous leukemia in 1999, has taken a series of oral chemotherapy drugs since his diagnosis.

"I don't understand how the people in the Legislature can look at this bill and say it is not good," said Logan, a Republican and small business owner. "It is simply common sense. It's something that shouldn't even have been subject to debate."

Logan's last health plan had a cap of $10,000 a year in out-of-pocket expenses for prescription drugs. This was in addition to the out-of-pocket expenses for his medical coverage.

Phil Dougherty, senior executive officer of the Wisconsin Association of Health Plans, said lawmakers also need to look at the needs of other consumers and their employers. The bill sets a "dangerous precedent" for the Legislature to meddle with the design of coverage plans, he said.

"What about other drugs that are very expensive as well?" Dougherty asked.

The association also has stressed that the bill would raise premiums, though Dougherty acknowledged that he doesn't have specific figures on the increase.

Strachota and other supporters of the law note similar bills in other states have had a negligible effect on premiums.They say traditional chemotherapy administered at a clinic or hospital can be as costly as oral chemotherapy drugs.

A review done by the Washington Department of Insurance found an increase of 0.2% as a result of the state's oral chemotherapy law, according to the International Myeloma Foundation. In Indiana, the Department of Insurance found no increase in premiums after it passed similar legislation in 2010.

Insurance industry groups also have said the law is not needed because many health plans cover oral chemo and the Affordable Care Act caps out-of-pocket expenses at $6,350 for an individual this year.

"That significantly changes the picture for people whose out-of-pocket costs are thousands of dollars," Dougherty said.

The Legislature's two most powerful lawmakers, Fitzgerald and Vos, aren't backing the bill.

Scott Fitzgerald said his efforts to hold up the bill are no different from last session, when his brother Jeff was serving as Assembly speaker and the chemotherapy bill also failed to pass.

Jeff Fitzgerald didn't respond to a request for comment. Since April 2013, he has served as a contract lobbyist for the Wisconsin Association of Health Plans, which opposes the bill along with individual insurers and another trade group, the Alliance of Health Insurers.

"This issue has been around a lot longer than Jeff has been working with the health plan groups," Scott Fitzgerald said. "Since 2011, the dynamics in my (Republican) caucus have not changed. Some members support it, and others view it as an expensive mandate."

But Democratic supporters like Erpenbach and Assembly Minority Leader Peter Barca (D-Kenosha) note that it has near unanimous backing from Democrats and, more importantly, many of the Legislature's other influential Republicans. Big drug companies and doctors groups support it.

Despite the bill's high-placed supporters, the measure is "not scheduled yet because the insurance companies have a lot of power," Erpenbach said.

Insurers are major donors to Republican lawmakers and have a history of giving to GOP legislators on both sides of the chemotherapy bill issue, such as Fitzgerald and Darling.

The question of how far the government should intervene in the health care market has become one of the most toxic issues in politics. The bitter debate over Obamacare has led lawmakers on both sides to dig deep ideological trenches.

The chemotherapy bill has brought many lawmakers out of those entrenched positions.

For now, the prospects look poor for Audrey Van Dyke and other supporters of the bill.

"It doesn't seem very logical or fair to the residents of Wisconsin," she said.