THE CANCER DRUG COVERAGE PARITY ACT
The Problem: Outdated Coverage Policies Limit Patients’ Access to New Lifesaving Drugs Insurance coverage has not kept pace with innovation in medicine and the growing trend towards orally administered chemotherapy. Traditionally, intravenous (IV) and injected treatments were the primary methods of chemotherapy delivery, which are covered under a health plan’s medical benefit where the patient is only required to pay a small office visit co-pay.
Today, oral chemotherapy has become more prevalent and is the standard of care for many types of cancer. Oral chemotherapy also accounts for approximately 35% of the oncology development pipeline. More importantly, many oral anti-cancer medications do not have IV or injected alternatives and are the only option for some cancer patients. As these medications become more prevalent in cancer treatment, they must be as affordable as their IV counterparts.
Since oral anti-cancer medications are often covered under a health plan’s prescription benefit, many patients are responsible for extremely high and unmanageable co-pays. These co-pays can be hundreds or thousands of dollars per month and, as a result, almost 10% of patients choose not to fill their initial prescriptions for oral anti-cancer medications due to the high rates of cost-sharing.1
The Solution: The Cancer Drug Coverage Parity Act requires any health plan that provides coverage for cancer chemotherapy treatment to provide coverage for self administered anticancer medication at a cost no less favorable than the cost of IV, port administered, or injected anticancer medications. This law is not a mandate as it only applies to health plans that already cover chemotherapy. This bill ensures equality of access and insurance coverage for ALL anti-cancer regimens. Health insurance cost-sharing schemes should not create barriers to cancer patients’ ability to access potentially life-saving medicines
1Streeter SB, Schwartzberg L, Husain N, and Johnsrud M, Patient and Plan Characteristics Affecting Abandonment of
Oral Oncolytic Prescriptions. Journal of Oncology Practice. Vol. 7, Issue 3S: 46s-51s, 2011.