Abolishing High Co-pays for Oral Chemotherapy
Abolishing High Co-pays for Oral Chemotherapy
Amid concerns about the increasingly high cost of cancer treatment, action is again being taken in Washington, DC, to end the disparity between co-pays for intravenous (IV) and orally administered anticancer drugs. Under most current health insurance plans, intravenously infused or injected chemotherapies are covered under the medical benefit provision, whereas drugs taken orally fall under the prescription drug benefit, which often carries a very high patient cost-sharing component. The most expensive oral cancer drugs often appear in the top tier of the prescription drug formulary, with costs typically reaching $100,000 or more per year. The financial burdens born by patients prescribed these drugs can be very high, with co-pays running from hundreds up to thousands of dollars per month.
Around one quarter of anticancer agents in development are planned as oral drugs. Many of these new oral drugs have shown significant clinical advantages over traditional IV/injected forms of cancer treatment, and in some cases they represent the only viable treatment. However, the high co-pays have already been shown to adversely affect patients' treatment with these drugs in a number of ways. A survey of oncologists reported that 84% were influenced in their treatment recommendations by patients' out-of-pocket expenses (and insurance companies are likely to discourage the use of the most expensive drugs anyway).Even among patients with cancer who are prescribed the new oral drugs, about 10% choose not to fill their first prescriptions because of the high rates of cost sharing. Other reports have highlighted the associations among high co-pays, failure to adhere to chemotherapy, and the disastrous personal financial consequences of the high costs of treatment.
In April, legislation that would require health insurance companies to provide equal coverage and reimbursement for IV/injectable and orally administered anticancer medications was introduced in the House of Representatives by Rep. Brian Higgins (D-NY-26). The Cancer Drug Coverage Parity Act of 2013 (HR 1801) seeks to amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 "to require group and individual health insurance coverage and group health plans to provide for coverage of oral anticancer drugs on terms no less favorable than the coverage provided for anticancer medications administered by a health care provider." Companion legislation must be introduced and passed in the Senate before the bill can become law.
This is the third time Rep. Higgins has introduced such a bill; on the 2 previous occasions it was presented, it failed to clear committee. This time the bill has 30 bipartisan cosponsors (27 Democrats and 3 Republicans) and the support of numerous health professional, pharmaceutical, and patient organizations and cancer centers, including the American Society of Hematology (ASH).
Janis L. Abkowitz, MD, the current president of ASH, spoke to Linda Brookes, MSc, for Medscape, about the Cancer Drug Coverage Parity Act and the support the society is providing to help it pass Congress.
High Co-pays Take Their Toll
Amid concerns about the increasingly high cost of cancer treatment, action is again being taken in Washington, DC, to end the disparity between co-pays for intravenous (IV) and orally administered anticancer drugs. Under most current health insurance plans, intravenously infused or injected chemotherapies are covered under the medical benefit provision, whereas drugs taken orally fall under the prescription drug benefit, which often carries a very high patient cost-sharing component. The most expensive oral cancer drugs often appear in the top tier of the prescription drug formulary, with costs typically reaching $100,000 or more per year. The financial burdens born by patients prescribed these drugs can be very high, with co-pays running from hundreds up to thousands of dollars per month.
Around one quarter of anticancer agents in development are planned as oral drugs. Many of these new oral drugs have shown significant clinical advantages over traditional IV/injected forms of cancer treatment, and in some cases they represent the only viable treatment. However, the high co-pays have already been shown to adversely affect patients' treatment with these drugs in a number of ways. A survey of oncologists reported that 84% were influenced in their treatment recommendations by patients' out-of-pocket expenses (and insurance companies are likely to discourage the use of the most expensive drugs anyway).Even among patients with cancer who are prescribed the new oral drugs, about 10% choose not to fill their first prescriptions because of the high rates of cost sharing. Other reports have highlighted the associations among high co-pays, failure to adhere to chemotherapy, and the disastrous personal financial consequences of the high costs of treatment.
In April, legislation that would require health insurance companies to provide equal coverage and reimbursement for IV/injectable and orally administered anticancer medications was introduced in the House of Representatives by Rep. Brian Higgins (D-NY-26). The Cancer Drug Coverage Parity Act of 2013 (HR 1801) seeks to amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 "to require group and individual health insurance coverage and group health plans to provide for coverage of oral anticancer drugs on terms no less favorable than the coverage provided for anticancer medications administered by a health care provider." Companion legislation must be introduced and passed in the Senate before the bill can become law.
This is the third time Rep. Higgins has introduced such a bill; on the 2 previous occasions it was presented, it failed to clear committee. This time the bill has 30 bipartisan cosponsors (27 Democrats and 3 Republicans) and the support of numerous health professional, pharmaceutical, and patient organizations and cancer centers, including the American Society of Hematology (ASH).
Janis L. Abkowitz, MD, the current president of ASH, spoke to Linda Brookes, MSc, for Medscape, about the Cancer Drug Coverage Parity Act and the support the society is providing to help it pass Congress.