“Oral Parity”: Reducing the Cost of Cancer Care
In many ways this is a golden age of progress in the fight against blood cancer. For many Americans living with leukemia, lymphoma or myeloma, they have seen their cancer diagnosis transformed from a death sentence to a manageable chronic disease.
This is thanks in large part to the discovery of new, targeted drug therapies, many of which come in the form of a pill instead of being administered intravenously. Today tens of thousands of cancer patients rely on an oral therapy and, for patients living with certain cancer diagnoses, an oral drug is the only one available to treat their maladies. Many more of these cancer-fighting pills are on the way, too. It goes without saying, oral versus intravenous therapy contributes significantly to a patient’s improved quality of life.
With oral therapies having become central to the treatment of cancer, common sense would suggest health insurance should cover these therapies at a level similar to that provided for cancer therapies administered via other methods. But, shockingly, cancer patients who require oral therapy typically face much higher cost-sharing for their treatments than do patients who need IV therapy—even if the two drugs cost the same to the health plan.
Such burdensome out-of-pocket costs have led patients to skip their prescribed course of treatment and, even worse, forgo their treatments altogether. It’s not a surprise that this can lead to an increase in hospitalizations and doctor visits, not to mention poorer health outcomes. These scenarios increase costs for the patients themselves and for the overall health system as well. Without clear action, these costs will continue to rise as health plans shift more burdens onto the sickest patients.
The good news is there is a proved solution, often referred to as “oral parity.”
During the past decade 43 states have stepped forward to adopt oral parity by passing laws that require more equitable cost-sharing for the oral drugs used to treat cancer. Their governors—both liberal and conservative—have signed oral parity laws, which have a long track record of helping cancer patients without increasing premiums.
State laws apply to only certain types of health insurance plans, however. That’s why cancer patients need Congress to extend these same protections to the approximately 60 percent of Americans on private insurance whose benefits are regulated by federal law. Very similar to state oral parity laws, the Cancer Drug Parity Act (H.R. 1409) requires that a patient’s cost-share for an orally administered cancer treatment be no greater than that for a therapy administered by other methods, such as IV, a port or injection.
This bipartisan legislation was introduced in Congress by representatives. Leonard Lance (R–N.J.) and Brian Higgins (D–N.Y.) in March 2017, but since then there has been no action to move this through the legislative process. This is disheartening and directly affects patients’ ability to access the lifesaving treatments they need. Although there are many topics that divide lawmakers today, oral parity is one issue that both sides of the aisle should be able to agree on.
Critics of oral parity legislation say it doesn’t address the high cost of cancer drugs, leaving health insurers to deal with those costs by increasing premiums. But in the 43 states with an oral parity law, cancer patients have seen their costs go down without any evidence that parity has increased premiums for other plan holders. As for the cost of care, the Leukemia & Lymphoma Society (LLS) takes seriously its responsibility to help find solutions to the unsustainably high cost of care in this country. But delivering those solutions requires consensus building across the health care system, a process that has begun but which is far from its conclusion. In the meantime there are cancer patients with an urgent need to access the treatments prescribed to them. For these patients, oral parity can bring immediate, vital relief.
As a patients-first organization, the LLS is dedicated to removing barriers to care. We are calling on members of the U.S. House of Representatives, the cancer community and the public to raise their voices in support of the Cancer Drug Parity Act and ensure every privately insured cancer patient in the U.S. has access to the treatment they need to fight their disease.
For more than 68 years the LLS has invested in new medical research aimed at finding cures for leukemia, lymphoma and myeloma. Our success on this front has been tremendous. But we recognize that finding cures is not enough; we need to ensure patients have access to the treatments, services and health care providers they need to live longer, better, healthier lives.