Abolishing High Co-pays for Oral Chemotherapy

Is the Third Time the Charm for the Cancer Drug Coverage Parity Act?

Janis L. Abkowitz, MD; Linda Brookes, MSc

Disclosures

July 08, 2013

In This Article

Why Is a Federal Law Needed?

Medscape: Many states have already enacted their own drug parity laws, starting with Oregon in 2008. Why do you believe that a federal law is still necessary?

Dr. Abkowitz: Currently, 23 states and the District of Columbia have passed such bills. But that leaves 27 states with no laws at all, and at this rate it would take more than a decade for the remaining states to pass legislation. These state laws, including the one in my state, Washington, only apply to state-regulated insurance plans; that is, individual health plans, small group plans that are not self-insured (ie, regulated by ERISA, the Employment Retirement Income Security Act), and state employee plans. Patients who have federally regulated insurance plans, such as those [patients] on Medicare, need the same change in federal law to have equal access to treatment.

Medscape: Would this federal bill override the state's legislation?

Dr. Abkowitz: We would like to have this bill be implemented nationally so everyone has access. It would cover everyone and drive the state agendas.

Medscape: Under the Affordable Care Act, starting in 2014 everyone will have access to affordable health insurance options, and healthcare plans will no longer have set lifetime or annual dollar limits. Won't this help access to cancer drugs?

Dr. Abkowitz: The Affordable Care Act limits on out-of-pocket expenses only apply to essential health benefits. This means that only new small and individual group plans will have to comply. The Cancer Drug Coverage Parity Act applies to all private health insurance plans.

Medscape: The ACA will surely mean that more people will be able to get treated. Will this actually affect what patients pay for oral cancer drugs?

Dr. Abkowitz: That is a complex question. Part of the Affordable Health Care Act is to actually make pathways of care and to make decisions based on efficacies. So what it might do is change the use pattern. In other words, it might be that certain healthcare ACOs (accountable care organizations) will prioritize very effective medications and choose not to prescribe or support less-effective medications that are equally expensive.

Medscape: Such was the case in the widely reported decision made at Memorial Sloan-Kettering Cancer Center (New York) not to use a highly expensive new drug in colorectal cancer because there is another, less-expensive treatment already available that is considered as effective.[18]

Dr. Abkowitz: That sort of decision is going to occur more often, starting in 2014, as more ACOs are formed. Hospitals will establish associations that make bundled contracts with large employers for care. Pathways will be set for how particular diseases are to be treated. I think that very rightly these changes should be driven at the state and local levels because they relate to the particular populations that are being served.

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