Oral Parity Update 2013: Federal Edition
by Sydney Abbott, JD, Manager, Provider Economics and Public Policy, ACCC
The good news: oral parity legislation has already passed in almost half of the states. The bad news: the laws vary from state to state, and 27 states still have no law at all.
The solution: HR 1801, the bipartisan Cancer Drug Coverage Parity Act, introduced recently by U.S. Representatives Brian Higgins (D-NY) and Peter King (R-NY).
Currently, most IV-infused chemotherapies are covered under the medical benefit component of a health insurance plan, while orally administered drugs fall under the prescription drug benefit, which often carries a very high patient-cost-sharing component. The Higgins-King bill would eliminate the cost-sharing disparity by requiring insurance companies to cover orally administered prescription drugs at a cost no less favorable than their infused counterparts. Legislation such as this is particularly important as the oncology drug development pipeline increasingly consists of oral anti-cancer medications. Some estimates are that over the next decade the oncology pipeline will include up to 30% oral anti-cancer drugs.
So why is ACCC pushing for oral parity legislation at both the federal and state level? The answer is simple: we want to achieve parity across every state as quickly as possible. While federal legislation is preferable because it would negate the need for individual state laws and would cover every patient equally from coast to coast, the current political climate on Capitol Hill is such that legislation regulating insurance companies can be unpopular and difficult to move through both houses of Congress. In fact, Representative Higgins introduced this same bill in the last Congress, but the legislation never made it through committee or to the House floor for a vote. Additionally, companion legislation must be introduced and passed in the Senate before the bill can become law. ACCC continues to work with other organizations to identify a Senate sponsor for a companion bill.
State legislation, on the other hand, generally moves faster due, in part, to the fact that most state legislatures are only in session for a portion of the year. Over the past five years, 23 states plus Washington, DC, have been able to pass their own oral parity bills while Congress has been unable to pass one. For this reason, ACCC will continue to advocate for oral parity with a two-pronged approach until every patient in the U.S. has access to the most appropriate anti-cancer medication at the most appropriate time. Please visit the ACCC Legislative Action Center for more ways to get involved in this issue and others impacting cancer care. ACCC will keep members current on HR 1801, as well as progress on state-level legislation.