Subject: Oral Chemotherapy Parity
Posted by Dave Berry
Gate Way Group Contact: Deanna Hemphill
Issue Summary: Anti-cancer medications administered intravenously are traditionally covered under the medical benefit portion of a cancer patient’s insurance plan, generally requiring about a $30 co-pay. However, patients on an oral anti-cancer regimen are covered under their pharmacy benefit, which often requires a cost-sharing component that is some percentage of the total cost of the drug. In the case of oral anti-cancer medications, that can be thousands of dollars out of pocket every month.
The question being asked then is should private insurance plans be prohibited from charging higher out-of-pocket costs for orally administered chemotherapy medications than intravenously administered medications in the state of Missouri?
As of 2013, 26 states believe so having passed some form of oral parity legislation while additional states have legislation in the pipeline. Meanwhile, the insurance industry claims the Affordable Care Act prevents mandates in any state. Proponents of the measure including the Leukemia & Lymphoma Society argue it is not a mandate as there is no requirement to offer the treatment.
During the 2013 legislative session, Missouri lawmakers took a step in this direction passing Senate Bill 262. A key component of this bill was the formation of the Missouri Oral Chemotherapy Parity Interim Committee which conducted a number of hearings over the past several months for the purpose of studying the disparity in patient co-payments between orally and intravenously administered chemotherapy, the reasons for the disparity, and the patient benefits in established co-payment parity between oral and infused chemotherapy agents.”
The final report, containing the committee’s findings, was submitted to Speaker Tim Jones December 31, 2013.
Two identical bills were filed this week in the Missouri Senate requiring insurers (that are already offering oral and intravenously administered chemotherapy treatment) to require the same out-of-pocket costs for an oral form of chemotherapy. This measure does not require insurers to cover oral chemotherapy medication; however, as noted above, insurers who carry the drugs can no longer charge a higher co-pay, deductible, or coinsurance for oral treatments versus intravenous treatments. See below for the two Senate Bills: