Oral Drug Parity: Insurance companies force some patients to pay more for prescribed treatment

What is oral drug parity?

What is oral drug parity? That’s the effort to guarantee fairness in insurance policies and ensure that every patient has access to the right treatment.

As hard as it is to believe, insurance companies can legally charge cancer patients more if their treatment comes in a pill form. The same treatment given by an IV in a hospital — costs a patient less money out-of-pocket.

“Oral cancer drugs play an increasingly important role in my day-to-day care of cancer patients,” Dr. Philip Stella, a physician in Michigan’s St. Joseph Health System, wrote earlier this year in a Detroit News opinion piece. “Sometimes oral medications represent the only or best treatment option, making them a non-negotiable part of a thoughtful plan of care… Many patients are finding their health plans don’t cover oral chemo drugs in the same way they do more traditional methods of IV chemotherapy.”

Oral parity laws require insurance companies to provide equal coverage for both IV and pill treatments.

Patients Rising’s Perspective: We need oral parity to get the right treatment to the right patient

Here at Patients Rising, we believe that oral parity laws are about getting the right treatment to the right patient. A patient shouldn’t be forced to pay more money to gain access to the treatment prescribed by their doctor.

According to the American Society of Clinical Oncology, the world’s leading professional organization representing physicians who care for people with cancer:

  • Oral oncology drugs are often more convenient for patients who otherwise must travel to receive outpatient treatment at a hospital or doctor’s office.
  • It is estimated that as many as 10 percent of cancer patients do not fill oral prescriptions – and, thus, do not receive their recommended cancer treatment – due to high out-of-pocket costs.
  • Lower out-of-pocket costs for patients mean they are more likely to adhere to their anticancer regimen as several studies have shown that the higher the cost-sharing amounts, the less likely patients are to follow through on their treatment.

How is this legal? Insurance companies are exploiting legal loopholes created by out-dated laws that haven’t kept up with new innovations.

“Since patient administered anti-cancer medications are often covered under a health plan’s prescription benefit, many patients are responsible for extremely high and unmanageable co-pays,” explains the Patients Equal Access Coalition, a group working to change the law. “These co-pays can be hundreds or thousands of dollars per month and, as a result, almost 10% of patients choose not to fill their initial prescriptions for oral anti-cancer medications due to the high rates of cost-sharing.”

Federal Legislation: Support the Cancer Drug Coverage Parity Act

Federal legislation would fix this broken system. The Cancer Drug Coverage Parity Act would stop insurance companies from exploiting the law.

Under the proposal, health plans would be required to provide equal coverage regardless of whether cancer chemotherapy treatments are delivered by pill, IV or injection. This summer, the Patients Equal Access Coalition along with the International Myeloma Foundation rallied patients to Capitol Hill to urge lawmakers to stand up for patients’ rights.

You can read the legislation by clicking the links below:

Video: “Instead of Infusion– It’s a Pill”

Due to an outdated insurance benefit design, cancer patients across the country are not able to afford their oral anticancer medications. Please take a moment to hear from the patients themselves, and learn about what we are doing to find a solution.

Map: Oral drug parity laws vary from state to state

The State Patients Equal Access Coalition has been hard at work ensuring patients have access to the treatments that are recommended by their physicians through the oral chemotherapy parity legislation around the country.

Thanks to their work — and patient advocacy groups across the country — 42 states and the District of Columbia have passed oral parity laws. Does your state protect the rights of patients?
Oral Chemotherapy laws by state

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