A bipartisan group of House and Senate legislators introduced 聽last week that would require health plans to cover the growing number of oral chemotherapy pills as favorably as they do intravenous chemotherapy. But an insurance trade group says that as long as drugmakers continue to increase the prices of the oral聽drugs,聽parity legislation amounts to a 鈥渟hell game鈥 that will push up everyone鈥檚 premiums.
In recent years, states have passed oral chemotherapy parity laws at a steady clip. They鈥檙e聽on the books in 39 states and the District of Columbia, according to the American Cancer Society鈥檚 Cancer Action Network.
A federal law would ensure equal access across all states, says Anna Howard of the ACS Cancer Action Network.
Proponents also say the bill is needed to because聽private聽self-funded health plans that pay their employee claims directly generally don鈥檛 have to comply with state parity laws.
About a quarter of chemotherapy drugs in the pipeline are oral cancer medications, Howard says.
that were introduced in the previous congressional聽session didn鈥檛 advance. It鈥檚 unclear that the current bills have any better chance.
Patients who receive intravenous chemotherapy typically pay a flat copayment (perhaps $50) for an outpatient visit. Oral chemotherapy pills are covered under a plan鈥檚 pharmacy benefit, however, that may require coinsurance of 20 percent or more that for some drugs can run thousands of dollars.
Under the health law, consumers are limited in how much they can be required to pay out of pocket annually for care. (The only exception is for enrollees in plans that are grandfathered under the law.)聽 In 2015, are $6,600 for individuals and $13,200 for family coverage.
Still, 鈥渕any individuals don鈥檛 have an extra $6,600 in their bank account in order to get up to their out-of-pocket maximum,鈥 Howard says.
The proposed bill would require聽plans to cover chemo pills on terms 鈥渘o less favorable鈥 than their coverage for IV chemotherapy drugs.
But with the price tag for some oral cancer drugs well into six figures for a course of treatment, consumer premiums are bound to rise if insurers have to absorb the lion鈥檚 share of a drug鈥檚 cost, says Clare Krusing, press secretary at America鈥檚 Health Insurance Plans, a trade group.
鈥淭his legislation would place an arbitrary limit on cost-sharing between medical and pharmacy benefits, forcing premiums to increase for all consumers as a result,鈥 Krusing says.
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