The American Cancer Society estimates that 1.7 million Americans will be newly diagnosed with cancer this year. Will you be one of them?
Cancer is a sword of Damocles hanging over everyone’s head. It could strike us or a loved one at any time. For many of us it already has.
Now for the good news: Due to medical breakthroughs in recent years, including more targeted and effective chemotherapies, most cancers are survivable. With the right chemotherapy treatments, it is now possible to live a flourishing life following a cancer diagnosis. The death rate for cancer has fallen by 26 percent since 1991, resulting in 2.4 million lives saved.
Unfortunately, there is a catch. The biggest barrier to successful cancer treatment today often isn’t the existence of the right treatment, but the access to it. Due to a quirk in how Medicare and private insurance plans cover cancer drugs, chemotherapy in the preferred pill form costs patients thousands of dollars a month whereas intravenous drugs administered in a hospital or oncologist’s office may only require a small copay. Passing the Cancer Drug Coverage Parity Act, currently before Congress, would help improve accessibility by eliminating this pricing disparity.
Cancer treatments have advanced in recent years, not only in effectiveness but also in administration. Now, most chemotherapy treatments can be taken in pill form in the comfort of one’s home.
This not only spares patients from getting a long needle dozens of times over the course of treatment but eliminates the time traveling to and from the hospital or clinic and spending hours waiting to get care.
Yet insurance coverage has not kept up with the evolution of cancer therapies. Rather than paying for all cancer medicines equally, health plans classify IV drugs as a “medical benefit” and oral therapies as a “pharmacy benefit” and burden patients with far greater copayments for oral medications.
Additionally, roughly one-third of new chemotherapies only exist in pill form, meaning patients treated with the newest and best therapies have no other option. For instance, the most widely used drug for brain cancer is temozolomide and it is virtually always prescribed in pill form. Gleevec is the treatment for a deadly form of leukemia that only comes in pill form. There is no IV alternative.
In theory, oral drugs should be less expensive due to the lower costs of self-administered treatment. But due to the current system, patients can pay five times as much for a needed therapy, or $10,000 per treatment, simply because they swallow a pill.
As a result, some patients forego their treatment altogether due to the added cost burden. A new study in the journal Oncology finds that nearly 50 percent of patients abandon cancer therapy when their out of pocket costs reached more than $2,000. The health implications of forgoing chemo are obvious.
Recognizing the unfairness of the status quo, 43 states have passed laws mandating parity. But this doesn’t apply to federally-mandated plans like Medicare or many employer-sponsored plans. That’s why Congress must pass the Cancer Drug Coverage Parity Act, which would expand parity to the federal level.
Introduced by Rep. Leonard Lance (R-N.J.) and Rep. Brian Higgins (D-N.Y), this bill would require health plans cover oral anticancer medications and injectable therapies equitably so patients pay the same cost percentage for each type of treatment.
Bipartisan support should exist for this legislation. As election season nears, this is one of the few bills that doesn’t have an entrenched opposition, yet has a very sympathetic constituency — cancer patients. Also, studies in states with oral chemotherapy parity laws such as Vermont, Texas, and Indiana, show that passing the Cancer Drug Coverage Parity Act will have no appreciable effect on insurance premiums.
Passing the Cancer Drug Coverage Parity Act not only corrects an injustice for patients but it will accelerate improvements in cancer survival rates, making us all breathe a little easier.
Terry Wilcox is the co-founder and executive director of Patients Rising, a patient advocacy organization. This OpEd was first published in The Hill on March 26, 2018.