March 15, 2009
The emergence of clinically safe and effective, orally administered anticancer medication has significantly increased the treatment options for cancer patients. However, many barriers currently impede the adoption of orally administered treatment as mainstay cancer therapy.
One of the most significant barriers, which reflects the disparity between medical and pharmacy benefit design, is greater patient out-of-pocket responsibilities for oral therapies covered under the pharmacy benefit than the out-of-pocket costs for the IV therapies covered under the medical benefit. Therefore, patient access to potentially life-saving oral anticancer therapies is impeded.
This bill would require that a health benefit plan that provides coverage for cancer chemotherapy treatment must provide coverage for a prescribed, orally administered anticancer medication on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits.