Oral Chemotherapy Parity: Slowly but Surely…

Posted in ACCC News, Advocacy, Healthcare Reform, In and Around Washington, DC by ACCCBuzz on July 18, 2013

cost disparitiesBy Sydney Abbott, JD, Manager, Policy and Provider Economics, ACCC

Congratulations ACCC members in Rhode Island! On Wednesday, July 17, your state became the most recent to sign oral parity legislation into law. This brings the total number of states with oral parity legislation to 26. In 2013, six states have passed oral parity legislation (Florida, Oklahoma, Massachusetts, Nevada, Utah, and now Rhode Island)—clearly oral chemotherapy parity legislation is gaining momentum among the states. See Oral Anticancer Treatment Access Map here.

By now you know that oral parity helps patients access their life-saving drugs by prohibiting private insurance plans from charging higher out-of-pocket costs for oral medications than for IV-infused medications. Cancer patients receiving IV-infusions through the physician office setting are covered under the medical benefit of their insurance plan, generally requiring about a $30 co-pay. However, patients on an oral chemotherapy regimen are covered under their pharmacy benefit, which often requires a cost-sharing component that is some percentage of the total cost of the drug. In the case of oral anti-cancer medications, that can be thousands of dollars out of pocket every month.

It has taken six years to get half of the states to pass these laws and Congress has yet to pass a federal measure, even though bills have been introduced in the past few years. So, why would anyone oppose such patient-focused legislation? There are a few common misconceptions about oral parity legislation that makes some legislators skittish:

  1. Given all of the controversy over the “personal mandate” in the Affordable Care Act (ACA), anything perceived as a mandate is given a bad name. Parity legislation is often viewed as mandating insurance plan coverage of oral therapies. However, this is not correct. Parity legislation, whether state-level or federal, only applies to health plans that already cover chemotherapy; there is no mandate to offer coverage for benefits not already provided.
  2. Oral chemotherapy drugs are much more expensive than their IV counterparts, so some believe oral parity legislation should not be supported in order to keep the total cost of healthcare down. This is not true when you take the whole picture into account. IV-infusion therapies involve additional costs such as facilities charges, nurse and/or physician time, and materials used to administer the therapy. It’s also important to consider the cost of time and loss of productivity for cancer patients who receive infusions and their caregivers. In addition, overall healthcare costs are higher if there are complications from administering an IV therapy, such as having to treat an infection at the site of infusion.
  3. Finally, some believe passing parity legislation would significantly raise insurance premiums for everyone. Studies conducted in states that have passed parity legislation, for example, Indiana, Texas and Vermont, show that any increases in insurance premiums are negligible.

ACCC continues to fight for oral parity legislation on both the state and federal level. While ACCC is pleased that six more states have passed parity legislation this year, we must be vigilant at the federal level, as well. State legislation only impacts individual health plans and small group plans that are not regulated by ERISA. Only federal legislation will cover patients participating in ERISA-regulated plans.

That’s why ACCC is joining forces with others in the oncology care advocacy community to fight for HR 1801, the federal oral parity bill, at today’s 2013 Patient Equal Access Coalition (PEAC) Hill Day.

ACCC asks its members to support this important bill. Click here to compose a message to your legislator in support of HR 1801.

One Response

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  1. […] thousands of dollars a month in cost sharing for expensive oral drugs, with no cap according to a blog post from the Association of Community Cancer […]

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