Myths & Facts about Chemotherapy Parity & The Cancer Drug Coverage Parity Act

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MYTH: Oral Chemotherapy Drugs are More Expensive than IV Drugs
FACT: Oral Chemotherapy Drugs can be LESS Expensive

  •  Some oral anticancer drugs are less expensive to the insurer than their IV or injected alternatives.
  •  Additional costs are generated for IV therapies, such as facilities charges, the nurse’s or physician’s time and the materials used to administer the drug. There are also significant costs of time and lost productivity for individuals who receive IV chemotherapy and their caregivers.
  •  Overall healthcare costs can be higher if there are complications from administering an IV therapy, such as having to treat a patient for an infection at the site of  administration.

MYTH: Patients can choose between oral and IV forms of chemotherapy.
FACT: Patients frequently cannot choose between types of chemotherapy.

  • Many kinds of chemotherapy come in only oral forms, so patients do not have the  choice of which delivery mechanism they prefer.

MYTH: Patient-administered forms of chemotherapy have lower adherence than IV forms.
FACT: Patient-administered forms of chemotherapy do NOT have lower adherence.

  • Insurance benefit design poses the largest problem to patients complying with their  treatment regimens, since they are required to pay such high co-payments for oral forms.

MYTH: Oral Chemotherapy is not as effective as IV forms of chemotherapy.
FACT: Oral chemotherapy is just as effective as IV forms of chemotherapy.

  • Oral chemotherapy is just as effective as IV forms. In fact, in some cases it is even more  effective, since the chemotherapy can better target the cancer cells and reduce the side effects that patients experience.

MYTH: The Cancer Drug Coverage Parity Act is a Mandate
FACT: The Cancer Drug Coverage Parity Act is NOT a mandate

  • The Cancer Drug Coverage Parity Act ensures that health plans that cover  chemotherapy must cover oral chemotherapy at the same reimbursement rate as chemotherapy given via IV or injection.
  • Since it only applies to health plans that already cover chemotherapy, it is not a  mandate.

MYTH: The Affordable Care Act solves this problem.
FACT: The ACA does NOT solve this problem for all people.

  • The ACA limits on out of pocket expenses only apply to the essential health benefits,  which means that only new small and individual group plans will have to comply.
  • The Cancer Drug Coverage Parity Act would apply to all private health insurance plans, benefiting those who are on ERISA-regulated plans as well as existing small and individual group plans.

MYTH: Since states are passing their own chemotherapy parity laws, there is no need for a
federal law.
FACT: There remains a need for federal legislation.

  •  Since 2007, 21 states and the District of Columbia have passed chemotherapy parity legislation. At the current rate of passage, it would take more than a decade for the remaining states to pass legislation.
  • State legislation only impacts individual health plans, small group plans that are not  self-insured (regulated by ERISA), and state employee plans. Only federal legislation such as the Cancer Drug Coverage Parity Act will cover cancer patients participating in ERISA-regulated plans.

MYTH: The Cancer Drug Coverage Parity Act would significantly raise premiums for everyone.
FACT: The Cancer Drug Coverage Parity Act will NOT significantly raise insurance premiums.

  • Studies conducted in states that have oral chemotherapy parity laws such as Vermont, Texas, and Indiana have concluded that any raises in health insurance premiums have been negligible.
  • One study found that the cost to expand coverage to include oral chemotherapy for most benefit plans is under $0.50 per member per month (a mere 0.17% increase).1

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1 Journal of Medical Economics. 2009 Volume 12 No 3. Cost of oral capecitabine compared to intravenous taxane-based
chemotherapy in first line metastatic breast cancer.

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