Their Cancer Drug Parity Act Would Help Lower Out-of-Pocket Medical Costs for Oral Cancer Medications

WASHINGTON, D.C. [10/27/21]— U.S. Senators Tina Smith (D-Minn) and Jerry Moran (R-Kans.) today introduced bipartisan legislation to ensure cancer patients who receive oral medications are not hit with thousands of dollars in unaffordable out-of-pocket costs that health plans routinely cover for patients receiving traditional IV chemotherapy treatments. 

Their Cancer Drug Parity Act responds to the recent improvements in cancer drugs delivered orally by preventing insurers from charging cancer patients higher copayments for those medications than they charge those receiving their chemotherapy medicine intravenously.  Almost 2 million Americans are diagnosed with cancer each year.  In 2017, one in eight patients who were prescribed oral cancer drugs had copayments totaling more than $2,000.

“Oral cancer medications have seen significant improvements that make life better for cancer patients across the country,” said Sen. Smith.  “They are less intrusive than traditional IV treatments, allow patients to receive treatment in their homes, and have turned cancer into a manageable chronic disease for many. But while IV treatments are covered by a health plan’s medical benefits - with moderate to minimal copays - oral medications are self-administered and covered under pharmacy benefits,  leading to high, often-unaffordable copays.  It can add up to thousands of dollars in costs for patients each year and cause many to delay or forego necessary care to treat their cancer.  Our bill brings parity to these two kinds of treatments and lowers costs for those taking oral cancer drugs.”

“As cancer research and treatments continue to improve, it is essential to keep health insurance coverage on par with these medical advancements,” said Sen. Moran. “Our legislation builds on laws already implemented in over 40 states, including Kansas, to expand access to orally administered cancer drugs. Cancer patients should be able to immediately benefit from the cutting-edge treatments developed through American medical ingenuity, and making certain oral cancer drugs are affordable will improve efficiency of care for cancer patients.”

The bipartisan legislation is also supported by Senators Sheldon Whitehouse (D-RI), Richard Blumenthal (D-CT), Kevin Cramer (R-ND), Amy Klobuchar (D-MN), Roger Wicker (R-MS), John Boozman (R-AK), Jeff Merkley (D-OR), Shelly Moore Capito (R-WV), Cindy Hyde-Smith (R-MS), Chris Murphy (D-CT), Tammy Baldwin (D-WI), Sherrod Brown (D-OH), and Ed Markey (D-MA)

“We are grateful to Senators Smith and Moran for their tireless work to bring equitable insurance coverage to cancer treatments for the millions of patients this legislation will impact,” said Robin Levy, Senior Director of Public Policy and Advocacy for the International Myeloma Foundation who chairs the Coalition to Improve Access to Cancer Care.  “Along with their colleagues in the House, I’m confident we can pass the Cancer Drug Parity Act to ensure that patients are fighting their cancer, not for affordable access to the treatments they need.”

Creating Parity, Cutting Costs for Cancer Patients

The Senators said more than 40 states and the District of Columbia have enacted "oral parity" laws, which  prevent health plans from creating separate cost-sharing requirements for oral and self-administered cancer medicines.  They have made a significant difference for cancer patients.  In 2017, researchers found that in states with oral parity laws, zero-dollar copays more than tripled for oral cancer medications.

Senators Smith and Moran’s bipartisan Cancer Drug Parity Act would build on this state-level success by:

·        Expanding oral parity protections to privately-insured patients whose health care is regulated at the federal level. 

·        Preventing insurers from covering oral and self-administered medicines at different cost-sharing rates than IV chemotherapy.

·        Implementing these requirements for health plans that already cover both oral and IV chemotherapy treatments. 

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