Pennsylvania this week became the 41st state to pass controversial legislation aimed at making oral cancer drugs more affordable for patients.
The bill, which passed both chambers of the legislature unanimously Thursday, was headed to Gov. Wolf, whose office said Friday that he would sign it into law.
Out-of-pocket costs for intravenous chemotherapy – which requires going to a medical office for infusions – are much lower than patients’ costs for the more convenient oral medications. The new law equalizes the two.
Patient and physician groups who lobbied for the bill for three years cheered their victory, as did key sponsor Rep. Matt Baker (R., Tioga). “It has been a long road to get this legislation through the many hurdles,” Baker said. “I am hopeful the governor will sign this legislation in all haste in order to finally bring about needed relief to so many cancer patients and their families.”
So-called chemotherapy parity laws require private health insurers to cover oral drugs under “no less favorable” terms than infused chemotherapies, which are mostly older and less expensive medications.
Insurance companies usually cover intravenous chemo as a medical benefit because the drug is given in a hospital or doctor’s office, and patients are charged $20 to $50. In contrast, pills are covered as a pharmacy benefit, with the patient chipping in as much as 25 percent of the price; the copay can run $1,400, and $3,500 a month for newer oral drugs.
While the new legislation prohibits such disparate coverage, it also says insurers may require prior authorization for a drug, and may “consider the medical necessity and cost of oral chemotherapy medications compared with” infused or injected drugs.
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