The Bad News: Outdated Coverage Policies Limit Patients’ Access to Lifesaving Drugs
Insurance coverage has not kept pace with innovation in medicine and the growing trend towards orally administered cancer treatment. Traditionally, intravenous (IV) and injected treatments have been the primary methods of delivery, with coverage provided under a health plan’s medical benefit where the patient is required to pay a small office visit co-pay.
Today, oral anticancer medications have become more prevalent, are the standard of care for many types of cancer, and are often the only option for many cancer patients. Typically, oral anticancer medications are covered under a health plan’s prescription benefit, where many times patients are responsible for extremely high and unmanageable co-pays. This has created an enormous barrier preventing patients from accessing orally administered drugs. According to a recent study published in the Journal of Oncology Practice and American Journal of Managed Care, 10% of cancer patients failed to fill their initial prescriptions for oral anticancer medications due to high out-of-pocket costs.
The Good News: 26 States plus D.C. Have Laws in Place to Fix This
In an effort to remove this barrier to life-saving cancer treatments, 26 states plus the District of Columbia have implemented laws that require health plans currently covering cancer treatment, to provide more equitable out-of-pocket costs for IV/injected anticancer medications and oral anticancer medications.
1 Florida law goes into effect July 2014
2 Nevada law goes into effect January 2015
What to do if an insurance plan doesn’t comply
Contact the State’s Insurance Department. Click here for contact information.