Republican Sen. Alberta Darling of River Hills speaks Tuesday in support of her bill requiring equal coverage for chemotherapy in pill form. The bill passed the Senate, 30-2. Credit: Associated Press

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Madison — The state Senate overwhelmingly voted Tuesday to help curb costs for cancer patients taking chemotherapy pills — and another vote was scheduled for Thursday in the Assembly, where Republicans could still make changes that could kill the measure.

GOP Gov. Scott Walker hadn't taken a firm position on the measure by late Tuesday, though his spokeswoman, Laurel Patrick, said Walker would likely be "inclined" to sign it if the Assembly backs the measure by as wide a margin as the Senate did.

Walker's Democratic opponent, Mary Burke, supports the bill.

The proposal — approved 30-2 by the Senate — would require health plans to provide the same coverage for expensive chemotherapy drugs taken as pills at home as they do for the expensive chemotherapy administered through IVs at hospitals or clinics.

"Oral chemo is the wave of the future," said Sen. Alberta Darling (R-River Hills), a breast cancer survivor and lead sponsor of the measure in her house. "In a big way today we're bringing our statutes up to speed of the technology of this drug."

Supporters of the measure urged Walker and Assembly Republicans to swiftly approve the bill as passed by the Senate.

Walker is "apparently the only person in this state who doesn't understand the plight of cancer victims," said Sen. Bob Jauch (D-Poplar). "Thirty-to-two ought to tell him he should support the bill."

Assembly Speaker Robin Vos (R-Rochester) said GOP lawmakers in his house may seek to amend the measure when they take it up Thursday.

If changes are made, they could keep the bill from reaching Walker. The Assembly wraps up its work for the year Thursday and the Senate meets for the last time April 1. Both houses have to agree to an identical version of the bill to forward it to Walker.

"We are going to put this bill on the calendar and we're going to have a full discussion about what it's going to be," Vos said. "We're going to discuss some things to make it as effective as possible."

Rep. John Nygren (R-Marinette), an opponent of the bill, said Assembly Republicans were looking at capping the amount that insurers could charge consumers for oral chemotherapy each month. California and Missouri have gone that route, he noted.

"It's a discussion. It's not a definite," he said.

Last year, California passed an oral chemotherapy bill that limits out-of-pocket expenses to $200 for a 30-day supply of pills.

In 2012, California Gov. Jerry Brown vetoed an earlier version of the measure because the bill didn't "distinguish between health plans and insurers who make these drugs available at a reasonable cost and those who do not."

Missouri's Republican-controlled Legislature voted to cap patient out-of-pocket costs to $75 for a 30-day supply of oral chemotherapy pills if the company offers those drugs as well as intravenous treatments. The cap could increase annually but can't rise above the consumer price index.

Missouri Gov. Jay Nixon, a Democrat, is expected to sign the bill into law Wednesday.

Democrats wary

WisconsinSenate Majority Leader Scott Fitzgerald (R-Juneau) said his chamber would review any changes to the bill the Assembly might make. But Democrats were wary, saying they feared Assembly Republicans would make changes as a means of keeping the bill from passing before the session ends.

"I've been around here a long time, and I know how this works," said Assembly Minority Leader Peter Barca (D-Kenosha).

Democrats attempted to hold a vote on the bill Tuesday, but Republicans blocked them on a party-line, 58-38 vote.

The measure has some support from Assembly Republicans, including Majority Leader Pat Strachota (R-West Bend). But about half of Assembly Republicans have refused to publicly state whether they are for or against it.

"I'm not saying anything about oral chemo," Rep. Dan LeMahieu (R-Cascade) said when asked about his position on the bill.

Much as Senate leaders did, Vos has used procedural traps to keep the bill from getting to the floor. Before the Senate vote, he said he did that to allow time for an "honest discussion" by his caucus, saying that Republicans still haven't discussed the proposal in depth privately.

He blamed Democrats for turning the issue into "nothing more than politics."

"It's not about the policy; it's about the politics," Vos said.

Democrats fired back. Rep. Amy Sue Vruwink (D-Milladore) recalled losing her mother and brother to pancreatic cancer and recounted how her uncle had colon cancer and many women in her family had had breast cancer.

"My God, get ahold of yourselves! Go to an oncology unit and look at the families," Vruwink told Republicans. "When I buried my brother six months ago, politics were the furthest thing from my mind."

The chemotherapy bill provoked something that is almost never seen on the Assembly floor — heated arguments between Republicans.

Before the session had even gotten fully started, Vos interrupted a discussion on the floor between Strachota and another Republican.

"Stop talking about it!" Vos told Strachota.

Vos said later that he had lost his cool — unusual for Vos, particularly with a fellow Republican — because he expected lawmakers of his party to stay together.

"People are supposed to work with you," he said.

Outcome was in doubt

The floor session was marked by moments Tuesday when the outcome was in doubt — a rarity in the Legislature, where almost every instant is choreographed in advance.

Nygren said the "other side isn't being told" by the news media.

He noted that the insurance companies opposing the bill aren't the only powerful interests lobbying on it. Lobbyists for the pharmaceutical giant GlaxoSmithKline Inc., for instance, are working to pass the chemotherapy bill.

In the Senate, Fitzgerald reversed course after bottling up the bill last week. He relented on holding the vote — and voted for the bill himself — after Democrats threatened to force repeated votes on the measure Tuesday and other leaders of Fitzgerald's own caucus demanded a vote on it.

Just two senators voted against the bill — Paul Farrow (R-Village of Pewaukee) and Leah Vukmir (R-Wauwatosa). Sen. Neal Kedzie (R-Elkhorn) was not present.

The hurdles for the bill in the Assembly remain significant. In that house, 24 of the 60 majority Republicans have refused to say where they stand on the measure. Six Assembly Republicans oppose the bill and seven say they are undecided.

At least 23 Assembly Republicans support the measure, as do all 39 Democrats, meaning the bill has at least 61 votes in the 99-member chamber.

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.

Health plans typically cover oral chemotherapy under prescription drug plans that can have high copays, and for some health plans, those copays could run into many thousands of dollars. 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 after the deductible is reached.

Supporters say requiring equal coverage for oral chemotherapy hasn't been shown to lead to big increases in health insurance premiums. 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.

Obamacare a factor

Opponents have noted the Affordable Care Act caps out-of-pocket expenses at $6,350 for an individual this year. Nygren has said the bill isn't needed because the Obamacare provision prevents situations that have occurred in the past where some insured patients faced tens of thousands of dollars in bills for oral chemotherapy.

Others have pointed out state laws govern how private insurance plans are covered, but not the federally regulated plans that larger self-insured employers offer their workers.

In recent weeks, legislative leaders have gone to extreme measures to block the bill.

Vos moved an Assembly version of the bill to another committee on Friday, triggering a legislative rule that makes it harder for supporters to force the bill to the floor for a vote.

Last week, Fitzgerald took the unusual step of setting up a phantom hearing in the Senate Committee on Organization, which he chairs. That committee exists to schedule bills and does not hold hearings, but Fitzgerald scheduled one because a Senate rule prevents pulling bills to the floor if they have a pending hearing. Once the Senate completed its work last week, Fitzgerald canceled the hearing, acknowledging he never intended to actually hold it.

Fitzgerald's brother Jeff, a former Assembly speaker, is lobbying against the bill for the Wisconsin Association of Health Plans, a trade group of health maintenance organizations. Scott Fitzgerald has said his brother's lobbying has not played a role in his work to thwart the bill.

Twitter: twitter.com/patrickdmarley and twitter.com/jasonmdstein

Bill Glauber of the Milwaukee Journal Sentinel staff contributed to this report.

What's next

The Senate on Tuesday overwhelmingly approved a measure to curb drug costs for cancer patients. That was the first of three steps necessary for the bill to become law.

■ The Assembly is to take up the measure Thursday but could change it, putting its passage in doubt.

■ If passed by the Assembly in its current form, the bill would go to Gov. Scott Walker, who has not stated a position, although an aide said he would be inclined to sign if the Assembly passes it by an overwhelming margin.