Oral parity laws enacted by states are designed to ensure that orally administered cancer drugs are not costlier for patients than anticancer drugs given by infusion at a clinic or hospital. These laws have resulted in modest reductions in out-of-pocket spending.
Many orally administered cancer medications are expensive and are usually covered under the prescription drug component of the health insurer’s plan. As a result, patients are often subject to substantially higher cost-sharing requirements for these drugs than for intravenously administered chemotherapeutic agents and other drugs covered under the medical benefit component of the plan.
“Advocates for parity have been concerned that differences in the coverage for medical and pharmacy benefits will mean that patients needing orally administered drugs will pay a larger share of the drug costs,” said Stacie B. Dusetzina, PhD, Associate Professor, Health Policy, and Ingram Associate Professor of Cancer Research, Vanderbilt University Medical Center, Nashville, TN.
Whereas 43 states and Washington, DC, have passed oral drug legislation, a law to ensure parity in pricing between infused drugs and their oral counterparts is absent at the federal level. In March 2019, the Cancer Drug Parity Act (H.R. 1730 in the House and S. 741 in the Senate) was introduced at the federal level to end the out-of-pocket cost disparity for certain anticancer treatments based solely on how insurers classify these medications.
H.R. 1730 requires health plans that cover anticancer medications administered by a healthcare provider to provide no less favorable cost-sharing for prescribed, patient-administered anticancer medications. This requirement applies to medications that are: (1) approved by the FDA; (2) medically necessary for the cancer treatment; and (3) clinically appropriate in terms of type, frequency, extent, site, and duration.
To comply with this requirement, health plans may not, with respect to anticancer medications: (1) change or replace benefits to increase out-of-pocket costs; (2) reclassify benefits to increase costs; or (3) apply more restrictive limitations to orally administered medications than to intravenously administered or injected medications.
The bill, which was referred to the House Committee on Energy and Commerce on March 13, 2019, has a total of 112 sponsors, with at least 50 representatives from each party.
“We are thrilled that this bipartisan group of leaders in both the House and Senate have come together to help cancer patients ensure that they have affordable access to all available treatments. When passed into law, the Cancer Drug Parity Act will ensure that cancer patients—who are in the fight of their lives—don’t have to fight for the medications their oncologist prescribes,” said Robin Levy, Senior Director, Public Policy and Advocacy, International Myeloma Foundation, who chairs the Coalition to Improve Access to Cancer Care.
The legislation addresses oral drug parity for patients with federally regulated group and self-insured health plans, and therefore will not apply to patients with Medicare, Ms Levy noted. “Both the House and Senate have seriously considered proposals that would create an out-of-pocket cap for Medicare patients, which would restrict what the patients would be required to pay for their drugs over the course of the year, and we’re supportive of that,” she said.
Until the Senate takes action on H.R. 1730, oral parity bills are pending in North Carolina and the Coalition to Improve Access to Cancer Care is looking to build coalitions in Michigan, Idaho, and South Carolina, adding to legislation that already exists in other states and Washington, DC.