Despite oral chemotherapy becoming a more common treatment for various types of cancer, health insurance coverage remains inconsistent for many of these treatments. In an attempt to remedy this issue, Representatives Gus Bilirakis (R-FL), Suzanne Bonamici (D-OR), Glenn Grothman (R-WI), Joe Morelle (D-NY), Brian Fitzpatrick (R-PA), Brian Higgins (D-NY), and Doris Matsui (D-CA) began co-leading a bipartisan bill introduced to the House on Nov. 8, 2023. According to a press release by Congressman Bilirakis’s office, the bill known as the Cancer Drug Parity Act lowers costs for cancer patients who are prescribed oral medications. It will accomplish this feat by requiring health insurers to provide coverage for oral cancer treatment that is equivalent to conventional intravenous treatments.
Nearly two million Americans a year are projected to be diagnosed with cancer, and oral cancer treatments “have proven to be a game-changer.” This is due to being less intrusive than intravenous treatments and because patients are able to receive this care in the comfort of their homes. Unfortunately, oral medications are financially taxing for cancer patients. The release noted that one in eight patients were saddled with copayments of at least $2,000 for their first prescription.
“Cancer patients should have access to whichever treatment gives them the best chance to fully recover,” Congressman Bilirakis said. “Technological advancements are improving patient outcomes while minimizing side effects. Patients deserve to benefit from these advancements. This important bill addresses this problem and enables patients to keep their primary focus on getting well.”
Over 40 states, including the District of Columbia, have enacted “oral parity” laws. These acts prevent health plans from implementing “separate cost-sharing requirements” for intravenous versus oral treatments and have significantly impacted cancer patients. According to Congressman Bilirakis’ office, from 2008 to 2017, analyses have found that the proportion of multiple myeloma patients initially charged $0 for oral medications more than quadrupled. The enactment of parity laws resulted in a 38 percent increase for multiple myeloma patients initially charged $0 for oral medications, from 11 to 49 percent.
Key provisions of the Cancer Drug Parity Act are as follows: “expanding oral parity protections to privately-insured patients under federal regulation, preventing insurers from covering oral and self-administered medicines at different cost-sharing rates than IV chemotherapy, and implementing these requirements for health plans that already cover both oral and IV chemotherapy treatments.”
Traditional intravenous treatments are regularly covered under the medical benefit component of a health insurance plan under the current law. Oral cancer medications, however, are frequently covered under the prescription drug component, which often results in a considerable disparity in cost.
This leaves patients with the responsibility of paying high and often unaffordable copays. The legislation would prohibit insurance companies from instituting more costly copayments on cancer patients for oral medications compared to intravenous treatments.
“As oral cancer medications continue to increase in number, affordable access to these less intrusive treatments is crucial to ensure the best possible care,” said Matsui. “Families and patients battling cancer should never have to forgo treatment or necessary care because of crippling costs. The bipartisan Cancer Drug Parity Act would end the disparity in coverage for oral treatments – putting power back in the hands of patients and providers to determine the best path to recovery.”