Oral cancer drugs warrant equal coverage

June 12, 2009

The disparity in coverage between oral and IV chemotherapy medication is a critical issue for patients and is being debated at the national and federal levels.

The disparity in coverage between oral and IV drugs/hospital procedures is getting legislative attention at the federal and state level.

The Cancer Drug Coverage Parity Act of 2009 (H.R. 2366), introduced by Rep. Brian Higgins (D-N.Y.). would require insurance parity for oral and intravenous drugs. H.R. 2366 would amend existing legislation to "require group and individual health insurance coverage and group health plans to provide coverage for oral cancer drugs on terms no less favorable than the coverage provided for intravenously administered anticancer medications.”

Meanwhile, in California, a bill recently passed by the state Senate Health Committee will require healthcare service plan contracts and health insurance policies that provide cancer chemotherapy treatment to cover oral anticancer medications and intravenous treatments equally.

SB 161, authored by Senator Roderick D. Wright (D-Inglewood), passed out of the committee 10-1. A similar measure to SB 161 was passed in Oregon and has been introduced in at least six other states, including Hawaii, Indiana, Washington, Oklahoma, Texas and New York.

The disparity in coverage between oral drugs and intravenous chemotherapy is a critical issue for many patients, according to Susie Novis, president and co-founder of the International Myeloma Foundation, Studio City, Calif.

“In the last few years we have seen dramatic and important advances in treatments for multiple myeloma and related cancers,” Novis says. “We believe patients should be able to take advantage of the treatment that is best for them, and not have to select their treatment based on insurance coverage. We question a system that reimburses the least for the most cost-effective treatments.”

Adds Brian G.M. Durie, MD, is chairman and co-founder of the International Myeloma Foundation and director for hematological malignancies at Aptium Oncology. “Physicians treating multiple myeloma and related blood cancers now have the availability of potent new classes of drugs that are multifunctional with a diverse impact on cell function and pathways,” says Dr. Durie, who is also myeloma specialist at Cedars-Sinai Outpatient Cancer Center and chairs the Myeloma Committee of the Southwest Oncology Group (SWOG). “As a practicing hematologist-oncologist, I need the freedom to prescribe therapies based on their potential efficacy. Something is very wrong when the largest side-effect is economic based upon inequitable and irrational differences in reimbursement.”

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