Representatives Glenn Grothman (WI-06), Suzanne Bonamici (D-OR), Gus Bilirakis (R-FL), Joe Morelle (D-NY), Brian Fitzpatrick (R-PA), Brian Higgins (D-NY), and Doris Matsui (D-CA) have co-lead the introduction of the Cancer Drug Parity Act. This bill lowers costs for cancer patients prescribed oral medications by requiring that health insurers provide coverage for oral cancer treatments that is equivalent to conventional intravenous (IV) treatments. Every year, approximately two million Americans are projected to receive a cancer diagnosis. For cancer patients, oral cancer treatments have proven to be a game-changer because they can be administered in the patient’s own home and are overall less intrusive than IV treatments. Despite their proven success and reliability, oral medications have proved costly for patients. A study of patients prescribed oral cancer medications found that one in eight faced copayments of $2,000 or more for their first prescription.
“Every American deserves the most effective cancer treatments available at the most affordable cost,” said Grothman. “As oral medications increase in popularity among cancer patients, we cannot allow outdated health insurance plans to prevent patients from opting for their preferred method of treatment. “I am glad both sides of the aisle have come together to lower costs for patients taking oral medications. Increased access to treatment, along with parity in the cancer drug marketplace, will improve patients’ well-being and help save lives.”
“As leaders of the Coalition to Improve Access to Cancer Care (CIACC), the International Myeloma Foundation proudly endorses the Cancer Drug Parity Act. This crucial piece of legislation would mark a significant stride towards increased access to life-saving treatments, particularly for patients reliant on orally administered anticancer treatments. By eliminating financial barriers, this act empowers individuals battling cancer and their healthcare providers to make informed treatment decisions without undue financial strain. It is imperative that we prioritize affordability and equal access to all forms of anticancer treatments chemotherapy, and the Cancer Drug Parity Act is a pivotal step towards achieving this goal,” said the International Myeloma Foundation.
“We’re thankful to Congressman Grothman for spearheading lifesaving policy that, for many patients, would equalize out-of-pocket costs for cancer drugs, whether they’re taken orally or delivered intravenously,” said Lisa Lacasse, President of the American Cancer Society Cancer Action Network. “Many new chemotherapies such as those in pill form can be easier to tolerate for patients and allow many to have a better quality of life. Ensuring health insurance plans cover cancer treatment at an affordable cost, regardless of how it’s administered, is key to ensuring access to the most innovative therapies for patients across the country.”
Background Information
Oral chemotherapy is becoming more common for many types of cancer, however, health insurance coverage for different types of cancer treatments is not uniform. Under current law, traditional IV/injectable treatments are routinely covered under the medical benefit component of a health insurance plan, while orally administered anti-cancer medications are generally covered under the prescription drug component, which often results in a considerable disparity in cost and leaving patients responsible for paying high and often unaffordable copays. This legislation accounts for the advancements in oral cancer treatments by prohibiting insurance companies from imposing pricier copayments on cancer patients compared to IV treatments. More than 40 states, including Wisconsin, and the District of Columbia have enacted “oral parity” laws, which prevent health plans from creating separate cost-sharing requirements for oral versus IV cancer medicines. These laws have made a significant difference for those suffering from cancer. For example, an analysis of health plan claims from 2008 to 2017 found that the proportion of multiple myeloma patients initially charged $0 for oral medications nearly quintupled, rising from 11 percent to 49 percent, with the enactment of oral parity laws. The Cancer Drug Parity Act will build on the success of state-level efforts to cancer patients whose health insurance is regulated at the federal level. The key provisions of the legislation include:
- 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.
- Implementing these requirements for health plans that already cover both oral and IV chemotherapy treatments.
