Why are some cancer treatments more expensive than others?

If you have cancer, the type of treatment your doctor prescribes may determine how your health insurance pays for it. If your doctor recommends intravenous (IV) chemotherapy, you will usually go to your doctor’s office or hospital outpatient center to get the treatment. Because it is given by a health care professional in a medical setting, IV chemotherapy is covered by insurance as a medical benefit and, like a regular doctor’s office visit, requires a co-pay for each visit. This type of insurance coverage limits how much you pay out of pocket for this type of cancer treatment.

Oral anti-cancer medications, however, are often covered by insurers as a prescription drug benefit. This means you could face a higher co-pay or co-insurance compared to IV chemotherapy – oftentimes thousands of dollars out of pocket. For some patients, an oral medication may be the only recommended treatment.

Many patients are being denied access to oral anti-cancer medicines or are required to pay out-of-pocket costs significantly greater than their counterparts receiving IV chemotherapy. For these patients, out-of-pocket costs can become the key factor in determining treatment, sometimes outweighing the potential medical benefit that could be achieved with an oral medicine.

In efforts to take insurance coverage out of the treatment decision process, a number of states have adopted or are considering legislation that requires health insurance companies to cover oral anti-cancer drugs like they cover IV cancer therapies, often called parity bills.

As of May 2015, laws for coverage parity in cancer treatments have been passed in 39 states and the District of Columbia. Currently pending at the federal level, U.S. HR1801, the Cancer Drug Coverage Parity Act of 2013 proposes that group or individual health plans provide coverage of prescribed, patient-administered medications on parity with IV chemotherapy.

Resource Center

Oral Oncology Parity Laws: Giving Cancer Patients Hope

UNITED STATES – ADJOURNED 2015-2016


Number: US (2015) [R] HR 2646 – Updated (Status 07/16/2016)
Sponsor: Rep. Murphy
Title: Helping Families in Mental Health Crisis Act of 2016
Status: Senate – Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Type of Action: Introduction and Referral – 07/14/2016


Number: US (2015) [R] HR 2739 – Updated (New 01/11/2016)
Sponsor: Rep. Lance
Title: Cancer Drug Coverage Parity Act of 2015
Status: Referred to the Subcommittee on Health.
Type of Action: Committee Consideration
Action By: House Energy and Commerce – 06/12/2015


Number: US (2015) [R] HR 3261 – Updated (New 01/11/2016)
Sponsor: Rep. Schakowsky
Title: Medicare Prescription Drug Savings and Choice Act of 2015


 

Find out if there is proposed legislation in your state and take action.