Another State Gets Chemo Parity

CURE, Fall 2011, Volume 10, Issue 3

Texas joins nine other states in requiring health insurance providers to cover oral chemo the same as I.V. treatments.

In May, Texas Governor Rick Perry signed legislation that requires health insurance providers to cover orally administered chemotherapy drugs in the same manner as intravenous cancer treatments. Nine other states and the District of Columbia have currently passed chemotherapy parity laws. Similar bills have been introduced in approximately 20 other states.

The Texas law has the potential to drastically reduce the economic burden placed upon a growing number of cancer patients who rely on inadequate healthcare plans to purchase their costly oral medications.

With oncology drug prices continuously escalating (rising 11.5 percent in 2010, according to the Medco 2011 Drug Trend Report), patients who can’t manage these high costs are left with few options. Some abandon medication altogether, especially in cases where there is no intravenous substitute.

A reason for this disparity is intravenous and oral cancer medications are typically filed under different benefit plans. Insurance policies typically cover most, if not all, costs related to intravenously administered chemotherapy. However, oral versions of the same drug are classified as prescription drugs, which requires the patient to pay a much larger copayment, or share of the cost, according to an April 2010 Office of Legislative Research report.

Both forms of chemotherapy have existed for decades, but oral medications have recently increased in number and indications for usage. In addition to the 40 oral chemotherapy drugs already approved by the Food and Drug Administration, 25 percent of the estimated 400 chemotherapy drugs under development are expected to be created in oral form, according to an August 2010 study by the Texas Department of Insurance. The problem is, only about 28 percent of these oral drugs have intravenous alternatives, forcing many patients to either pay the additional cost of oral medications or go without.