Ashira Vantrees, JD of Aimed Alliance discuss what the Cancer Drug Parity Act is and how it impacts various issues in oncology.
Could you briefly describe what the Cancer Drug Parity Act is?
Absolutely. So, the Cancer Drug Parity Act has been introduced in the Senate by Senator Tina Smith, and it’s been introduced in the House of Representatives by Representative Brian Higgins, and it’s federal legislation that if passed, would require health plans to have the same cost sharing requirements, that’s your co-pay, or your co-insurance, for oral chemotherapy treatments, IV chemotherapy treatments.
So, are there other issues in oncology that the Cancer Drug Parity Act addresses?
So, the Cancer Drug Parity Act primarily addresses the issue of co-pay parity. So, the issue of copay parity is that some health plans required different cost sharing and typically a higher cost sharing for oral treatment compared to IV treatments, and co-pay parity requires that health plan provide the same cost sharing requirements for the oral and IV treatment. And really the issue of copay parity really came up when health plans started charging patients with cancer a higher copay for oral chemotherapy treatments compared to their IV chemotherapy treatment, and so obviously, this is really upsetting for patients with cancer who had come to this decision with their healthcare provider that this oral chemotherapy treatment was the best option for them. And then what was happening is they would go to collect their medication, and then be hit with this unexpectedly higher copay, than what they were used to. So, in response to this practice by insurers and health plans, states are passing Oral Parity Laws which prohibited health plans from charging a higher cost sharing, so a co-pay or a co-insurance for oral chemotherapy compared to IV chemotherapy and the Cancer Drug Parity Act is the federal version of that state legislation.
And the reason federal legislation is needed is because while state laws are great, state laws don’t regulate all types of insurance. So, for example, state laws don’t regulate insurance that individuals get from their employer, federal legislation can do that, and so that’s why we need the Cancer Drug Parity Act to pass to ensure that patients with cancer when they’re choosing which treatment is the best for them, that’s not a decision they’re forced to make based on their cost sharing requirements.