How Oral Chemotherapy Access Laws Affect Your Patients

Wisconsin residents take note!  This is an issue currently affecting your state. Residents outside of WI can find out HERE where your state stands on Oral Chemotherapy Parity.

Although chemotherapy has traditionally been administered in IV form, years of successful research have resulted in oral forms of chemotherapy being developed.  This allows the patient to administer anticancer medications at home, saving time and money for both the patient and their caregiver through bypassing lost productivity with hours spent in the hospital for IV infusions. According to the Leukemia and Lymphoma Society, "These pills are not only less toxic than conventional IV chemotherapy, but they have turned once incurable cancers such as myeloma and breast cancer into manageable diseases."

Despite the advantages associated with oral forms of chemotherapy, in some states, patients are forced to choose between the chemotherapy that could save their lives or another one that is fully covered by their insurance. While IV and injectable forms of chemotherapy are normally covered under medical benefits of insurance, oral forms may be covered under outpatient prescription drug benefits, leaving the patient with significant out-of-pocket costs.  This is true even if the oral chemotherapy is the only treatment available.

The following states and the District of Columbia have enacted oral chemotherapy access laws: Oregon (2008),Indiana (2009), Iowa (2009), Hawaii (2009), District of Columbia (2009), Vermont (2010), Connecticut (2010), Kansas (2010), Colorado (2010), Minnesota (2010), Illinois (2011), New Mexico (2011), Texas (2011), New York (2011), Washington (2011) and New Jersey (2012), Virginia (2012), Maryland (2012), Nebraska (2012), Delaware (2012), Louisiana (2012), Massachusetts (2013), Oklahoma (2013), Utah (2013), Nevada (2013) Rhode Island (2013) and Florida (2013).

FACTS Concerning the Impact of Senate Bill 101/Assembly Bill 151 from the Leukemia and Lymphoma Society (LLS):

1. Are oral cancer treatments high-cost, experimental drugs?

FACT: No, ALL oral chemotherapy treatments currently available to cancer patients have successfully completed all necessary phases of the National Institute of Health's (NIH) clinical trials process and met strict patient safety and efficacy standards set forth by the U.S. Food and Drug Administration (FDA). Anticancer medications, whether they are administered in pill form or liquid that must be infused intravenously, are expensive. In some cases, there is little cost difference between oral and infused/IV chemotherapy. Additionally, there are costs associated with infused/IV chemotherapy (facility fees, nurse time, other drugs and supplies) that are not associated with oral chemotherapy since the pill is taken at home.

2. Do patients have the option to choose the less expensive intravenous chemotherapy?

FACT: Treating cancer is an expensive prospect, regardless of the therapy and one that more than 29,000 Wisconsin residents – 79 each day – will have to face this year; moreover, more than 11,000 will die from the disease. Equally important, many of the oral drugs currently in use do not have an IV equivalent, are only offered in oral form, and are specifically indicated as the first and most effective treatment for a range of cancers including Chronic Myeloid Leukemia (CML) and Multiple Myeloma, among others.

3. Does this bill only apply to state-regulated insurance coverage, which affects less than 30 percent of those with health coverage?

FACT: Unfortunately, Wisconsin's oral chemotherapy parity legislation does not apply to patients enrolled in self-insured plans and those with federal employee benefits as both are exempted from compliance with state law by the federal Employee Retirement Income Security Act (ERISA); it also does not apply to patients with Medicare.

However, passage of this important legislation will give countless cancer patients in Wisconsin access to the most effective treatments and federal legislation has been introduced to address this issue for Medicare beneficiaries and those exempted by ERISA.

4. Are oral chemotherapies as effective as intravenously (IV) administered treatments?

FACT: Yes, for myriad cancer patients, the most effective – and often only – treatment comes in oral form; these cancers include some forms of leukemia and multiple myeloma, among others. Additionally, numerous clinical trial study results published in the Journal of Clinical Oncology1, for a range of oral chemotherapy treatments, found oral therapies to be as effective as and often more effective than IV treatments. Study results also showed oral treatments as safe and often more convenient for patients. Thankfully, we are making advances in how we treat cancer. New cancer therapies specifically targeted to the molecular triggers of the disease are revolutionizing cancer treatment---and many of these new therapies come only in pill form.

5. Is this bill a mandate?

FACT: No, this bill is NOT a MANDATE which tells health plans that they must cover a service not currently offered as a covered service. The bill would only impact those plans that currently list chemotherapy as a covered service.

Many insurers in Wisconsin currently cover oral chemotherapy treatment for patients. This legislation simply requires those insurers to ensure patient access to needed therapies. The issue is inequity in out-of-pocket costs to patients in need of oral treatments vs. those whose oncologist has determined that IV is the most effective route for them. Typically, IV's are included under a patient's medical benefit and require a standard $15-$20 copayment, depending on the plan. However, oral cancer treatments are listed as part of the beneficiary's prescription drug coverage, where there is generally greater responsibility placed on patient in terms of out-of-pocket costs; these include deductibles and co-insurance, which demand the patient pay a percentage of the total cost of the drug. For an untold number of patients, these costs often run in the thousands of dollars each month.

Since 2010, The Leukemia & Lymphoma Society has led bipartisan legislation to ensure that cancer patients have equal access to anti-cancer medications, whether the drugs are delivered by IV/ infusion or in a pill form. Last session's "oral chemo parity" bill was co-sponsored by 43 legislators in Wisconsin- half Republicans, half Democrats--making the issue the most bipartisan of the session. The bill however did not move forward and was not passed into law.

Today, co-authors of the bill, Senator Alberta Darling (D) and Representative Pat Strachota (R) are prepared to re-introduce the bill in the upcoming weeks! There is so much momentum behind this issue. To date, 26 states and D.C. have passed similar legislation... meaning HALF of the nation has successfully passed this type of legislation! LET'S BE NEXT, WISCONSIN!

We hope you will join this exciting movement in Wisconsin and join in helping the LLS in passing this bill! For further clarification or greater detail about the LLS' Advocacy efforts, please contact Christina Lee, Patient Services Manager at Christina.Lee@LLS.org or 262-785-4220

More information can also be found on the Wisconsin Coalition for Cancer Treatment Access (WCCTA) Facebook page.