POWER PERSPECTIVE

Making the Case for Reimbursement Parity for All Cancer Meds

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I am living with two cancers, CLL and myelofibrosis. I have Medicare, a Medicare supplement and Medicare Part D. I have no co-pay for the infused therapies I receive for CLL (great!), but I have about $10,000 in cost per year for my oral myelofibrosis pills. Why the discrepancy? This article zeros in on the problem and what we each can do about it by sounding off.

In many ways this is a golden age of progress in the fight against blood cancer”

It’s almost a contradiction to see “golden age of progress” and “cancer” in the same sentence, but perusing the recent news, we found this in Scientific American of all places. It is in a commentary by Louis DeGennaro , head of The Leukemia & Lymphoma Society, the LLS.

Dr. DeGennaro uses his commentary to makes an eloquent case for oral drug parity, writing: “Shockingly, insurance typically covers chemotherapy taken via IV more generously than chemo taken by mouth, even when the two are similar in cost to the health plan.” It’s a topic we’re very familiar with and have written about ourselves. But we’d like to share with you some supporting facts and figures from the commentary. We offer this to help our constituents make the strong case that equal insurance reimbursement deserves and that our patients require. 

1. “Critics of oral parity legislation say it doesn’t address the high cost of cancer drugs, leaving health insurers to deal with those costs by increasing premiums. But in the 43 states with an oral parity law, cancer patients have seen their costs go down without any evidence that parity has increased premiums for other plan holders.”
2.  With higher co-pays for oral medications many patients don’t take all of their pills. In some cases, they don’t take them at all. This actually increases overall healthcare costs as patients get sicker, spend more time in the hospital and utilize greater healthcare services overall.
3. Patients need the treatments our doctors prescribe for us, not the medications our insurance plans will pay for. This imbalance in reimbursement denies patients “vital relief.”

Patient Power is proud and willing to join the LLS, The Patients Equal Access Coalition (PEAC, http://peac.myeloma.org/) and many of our own members to remind everyone to “call on members of the U.S. House of Representatives … to raise their voices in support of the Cancer Drug Parity Act and ensure every cancer patient in the U.S. has access to the treatment they need to fight their disease.” We urge you to share the article because these clear points will help make the case for equal reimbursement whether our treatment comes in a pill or a needle. And we believe these facts will silence those who claim oral drug parity will cost money. It won’t! It will save money and save lives.

It’s an issue I’ll continue to fight for as I speak around the country. Next Monday, January 22, I’ll be hosting a panel at the Precision Medicine World Conference in Silicon Valley to discuss increasing patient involvement in drug research and development and helping to shape clinical trials, aiming for more success stories. But discovering and developing new therapeutics is just one side of the equation. We also need to these new treatments and today we know that an increasing number of the newest discoveries come in the form of a pill.

Please join me in fighting for national oral parity and never hesitate to send me your story or comment to me at andrew@patientpowewr.info.

Andrew

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you. 

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Page last updated on January 18, 2018