Federal Legislative Visits ­ August 2011
Background and Talking Points for HR 2746,
The Cancer Coverage Parity Act

ISSUE BACKGROUND
Intravenous (IV) and injected treatments were once the primary methods of cancer treatment.
However, oral treatments have become more prevalent and are the standard care for many types of
cancer. Unfortunately, the insurance benefit design has not kept pace with this innovation. As it
stands now, IV treatments are covered under a health plan's medical benefit where the patient is
typically required to pay an office visit copay. Conversely, oral treatments are being covered under a
health plan's prescription benefit and many times, patients are responsible for extremely high and
unmanageable copays to fill these prescriptions. In some cases these out of pocket expenses can be
up to $3,000 per month or more which creates a huge barrier to accessing the life saving medications
that patients need. When an oral treatment is determined most effective, patients are sometimes
forced to make their treatment choice based on cost, rather than efficacy.
Many of these drugs are effective in cancer treatment, and often don't have IV or injected
alternatives. Currently, there are 40 oral anti-cancer medications that are Food and Drug
Administration (FDA)-approved, only nine of which have less expensive generic equivalents. It is
also estimated that oral drugs account for more than 25% of the oncology development pipeline, so
this will be a much bigger issue for cancer patients as time goes on when these treatments are
approved by the FDA.
In response to this issue, Representative Brian Higgins (D-NY) introduced HR 2746, the Cancer
Coverage Parity Act of 2011. HR 2746 ensures chemotherapy parity for cancer patients by
requiring:
Any health plan that provides coverage for cancer chemotherapy treatment shall provide
coverage for prescribed, orally administered anticancer medication that has been approved
by the FDA and is used to kill or slow the growth of cancerous cells.
Orally administered medication shall be provided at a cost to the covered person not to
exceed the coinsurance percentage or the copayment amount as is applied to the delivery of
an intravenously or port administered or an injected cancer medication prescribed for the
same purpose.
A health plan shall not achieve compliance with legislation by imposing an increase in patient
out-of-pocket costs with respect to anticancer medications used to kill or slow the growth of
cancerous cells.
Health plans shall not reclassify such anticancer medications, whether orally-administered,
intravenously or port administered or injected, as other than medical benefits to achieve
compliance with legislation.
Federal Legislative Visits ­ August 2011
Background and Talking Points for HR 2746,
The Cancer Coverage Parity Act

TALKING POINTS
Today, oral oncology therapies comprise about 10% available therapies. It is estimated that
25-35% of the medications in the oncology development pipeline are oral therapies.
Cancer patients should have equal access to all approved anticancer regimens regardless of
how they are delivered.
Patients and their physicians should make decisions about treatment based on what will give
the patient the best chance of survival, NOT based on insurance coverage.
Many new oral drugs do NOT have IV alternatives so there isn't a choice for treatment.
Since myeloma is a relapsing and remitting disease, patients will have to use all approved
treatments (including orals) at some point during the course of treatment. It is
IMPERATIVE that they have ACCESS to all of them EQUALLY.
Representative Brian Higgins (D-NY) has introduced HR 2746, the Cancer Coverage Parity
Act of 2011, which will achieve chemotherapy parity for cancer patients.
HR 2746 ensures that IF a health plan covers chemotherapy- they must cover oral
chemotherapy at the same reimbursement rate as chemotherapy given via IV or injection
This is not a mandate. It will only apply to health plans that already cover chemotherapy
THE ASK
Cosponsor HR 2746, the Cancer Coverage Parity Act of 2011.
Sample Meeting Request Letter
August 4, 2011
The Honorable [Name]
U.S. House of Representatives
Address
City, ST 12345
Sent Via Email: [Scheduler Email Address]
Dear Representative [Name]:
As a myeloma patient/caregiver, I am writing to request a meeting with you during the August
Congressional Recess period to discuss the issue of chemotherapy reimbursement parity. This is an
issue that affects not only myeloma patients, but a multitude of cancer patients across the board.,
Myeloma is a cancer in the bone marrow affecting production of red cells, white cells, and stem
cells. It is also called "multiple myeloma" because multiple areas of bone marrow may be involved.
Myeloma is the second most common blood cancer after lymphomas. Each year, approximately
20,000 Americans are diagnosed with myeloma and 10,000 lose their battle with this disease. At any
one time there are over 100,000 myeloma patients undergoing treatment for their disease in the U.S.
I would welcome the opportunity to discuss federal legislation that ensures access to all approved
cancer treatments for patients and look forward to meeting with you or your staff. If you have any
questions, or will be able to schedule a meeting, please have your staff contact [designated contact
person] at [phone and email address].
I appreciate your consideration and look forward to hearing from you.
Sincerely,
[Name]
[Address]
[City], [State] 12345
[Phone Number]
[E-mail]
Sample Thank-you and Follow-up Letter
[Date]
The Honorable [NAME] OR Staff Member(s) Name(s)
U.S. House of Representatives Address
City, State 12345
Dear [NAME]:
Thank you for meeting with us to discuss issues of importance to cancer patients in [STATE] and
around the country.
Intravenous (IV) and injected treatments were once the primary methods of cancer treatment.
However, oral treatments have become more prevalent and are the standard care for many types of
cancer. Insurance coverage has not kept up with this trend. Many of these drugs are effective in
cancer treatment, and often don't have IV or injected alternatives. Anti-cancer medications are very
expensive and higher cost-sharing required of patients for oral medications makes them much less
affordable. When an oral treatment is determined most effective, patients are sometimes forced to
make their treatment choice based on cost, rather than efficacy. This can be a large financial burden
on patients and potentially a life or death decision.
That is why all cancer patients in this country should be able to access the medications they need to
treat their disease. The Cancer Coverage Parity Act of 2011 (HR 2746) ensures that all cancer
patients have access to the anticancer medications they need regardless of how that medication is
delivered. This legislation is important to me and to the thousands of cancer patients living in
[STATE] today. We ask that [you/ the Representative] show [his/her] support for this issue by co-
sponsoring the bill.
We appreciate your interest in these efforts, and look forward to working with you on these critical
issues in the future.
Sincerely,
[Name]
[Address]
[City], [State] 12345
[Phone Number]
[E-mail]

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