As the Obama administration holds a forum this week on prescription prices, it’s important that we understand some of the underlying issues, including a lack of equality in patient-shared costs for oral therapies versus more conventionally administered injections or infusions.
Cancer patients continue to pay more for treatments administered in pill form than they do for injections or infusions because of the way that insurance companies have historically structured their plans.
“Sadly, patients who are on oral anticancer medicines are often discouraged by the high costs passed on to them by insurance plans,” Alan Eisenberg, vice president of Federal Government Relations at Celgene, said. “Insurance benefits have not kept up with the tremendous advances in cancer care.”
In response, patient advocacy groups have called for “oral parity laws,” which require health plans to provide equal coverage for all forms of cancer treatment. Advocates believe treatment decisions should be made by doctors and patients, not by archaic insurance plans that make oral therapies prohibitively expensive.
And the need for oral parity will only grow in importance; oral therapies represent more than 25 percent of the 400 anticancer treatments currently in development.
“There is no doubt that we still have a ways to go before we win the war on cancer,” Eisenberg said. “But through research and innovation, we’ve begun to win some key battles with oral therapies that are providing tremendous benefits for patients.”
Some of these benefits are obvious: patients can take their medication from the comfort of their homes instead of sacrificing family time or taking time off work to sit in the doctor’s office or hospital for their treatment. These oral therapies give patients more flexibility and a greater sense of normalcy in their lives.
This shift toward home treatment has also helped to reduce overall costs since it has eliminated some hospital charges. Hospital admissions for cancer care dropped from 64 percent in 1987 to 27 percent in 2005, thanks in part to oral therapies.
Beyond the convenience factor for patients, some oral anticancer therapies have more manageable side effects than chemotherapies; some may even be the most effective options available and have helped contribute to increased survival rates for certain cancers. For instance, the survival rate for multiple myeloma has increased by over 50 percent since 1990.
Insurance benefits have not kept up with the tremendous advances in cancer care.
While insurance companies call the pricing strategy a necessary evil to keep costs down for everyone, studies have shown that reigning in the cost of oral cancer treatments would have a minimal impact on insurance premiums for most.
And focusing solely on the costs ignores the value that new therapies offer. Countries that adopt new treatments earlier harvest the most value despite spending more. Between 1995 and 2007, the countries that had the highest increases in cancer care spending had the largest decreases in cancer mortality.
It’s time for insurance benefits to recognize the value of oral therapies, and many state legislators have already made strides.
Since 2007, 40 states and the District of Columbia have passed oral parity laws, which have helped to lower overall costs and improve quality of life for patients. Unfortunately, state-level laws only apply to single-state health plans and have no impact on patients enrolled in large multi-state plans, Medicare or Medicaid.
To ensure all cancer patients benefit from oral parity, Congress has introduced the Cancer Drug Coverage Parity Act of 2015. If passed, it will allow patients and physicians to choose the cancer therapy that is right for them, regardless of how they are administered.
Patient advocacy groups are encouraging patients and their families to show their support for a federal oral parity law by contacting their senators and representatives:
— LLS Advocacy (@LLSAdvocacy) September 30, 2015