American Society of Hematology

ASH Policy Statement in Support of Insurance Coverage Parity for All Cancer Treatments

Published on: February 14, 2014

ASH Policy Statement in Support of Insurance Coverage Parity for All Cancer Treatments

As an organization of physicians and scientists who care for desperately ill patients, including those with blood cancers such as leukemia, lymphoma, and myeloma, the American Society of Hematology (ASH) is supportive of efforts to provide insurance parity for all approved evidence-based cancer treatments.

Background

Traditionally, intravenous (IV) and injected treatments were the primary methods of chemotherapy delivery and were covered under a health plan’s medical benefit; the patient was only required to pay a small office visit co-pay. Today, patient-administered chemotherapy has become more prevalent and is the standard of care for many types of blood cancer. Patient-administered chemotherapy also accounts for approximately 35% of drugs in the oncology development pipeline. More importantly, many patient-administered anti-cancer medications do not have IV or injected alternatives and are the only option for some blood cancer patients.

Insurance coverage has not kept pace with innovation in medicine and the growing trend towards patient-administered chemotherapy. When a patient-administered 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.

While IV treatment is typically paid for as part of a health plan’s medical benefit, patient-administered anticancer drugs, including oral drugs like Gleevec (imatinib, used to treat patients with leukemia), Revlimid (lenalidomide, used to treat patients with multiple myeloma, mantle cell lymphoma, and MDS), and Xeloda (capecitabine, used to treat patients with breast cancer and colorectal cancer), as well as patient self-injectable drugs, are often only covered as a prescription benefit at a much lower rate. As a result, many patients are responsible for extremely high and unmanageable co-pays, which can be hundreds or even thousands of dollars per month. Though physician-administered intravenous and injected medications can be as expensive as (or even more expensive than) oral and other patient-administered therapies, the higher cost-sharing generally required of patients for patient-administered medications makes them much less affordable and, as a consequence, almost 10% of patients choose not to fill their initial prescriptions for these anti-cancer medications. As these medications become more prevalent in cancer treatment, they must be made as affordable as their IV counterparts.

ASH Policy

Every cancer patient should have access to the approved evidence-based treatments recommended by his or her physician. Patients should not suffer from cost discrimination based on the type of therapy provided or the mechanism for the delivery of that therapy. Health plans offering IV chemotherapy benefits to plan subscribers should be required to provide parity for patient- administered (both oral and self-injectable) anticancer chemotherapy medications.

Despite the fact that a number of states have adopted coverage parity laws, more needs to be done to ensure that parity is applied to all insurers. While ASH supports efforts by individual states to address this issue, there remains a need for federal legislation to ensure coverage parity for patients throughout the United States. Congress should pass legislation to require coverage parity for anticancer regimens regardless of delivery method including, but not limited to oral and intravenous drugs, injections, surgery, radiation, and transplantation.

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