'Chemo parity' bill again passes Pa. House

Patient and physician groups cheered Monday as the Pennsylvania House overwhelmingly passed legislation to equalize patients' out-of-pocket costs for oral and intravenous cancer drugs.

Patients currently may be charged thousands of dollars a month for cancer pills, vs. a $50 co-payment for a dose of a drug given through a vein, because most insurers cover the two formulations in different ways.

This is the second consecutive year the House has passed a bill; its prospects in the Senate are unclear.

"Chemotherapy parity laws" have passed in New Jersey and 33 other states, plus the District of Columbia. They require private health insurers to cover oral drugs under "no less favorable" terms than infused chemotherapies, which are mostly older and less expensive medications.

Proposed federal legislation would extend the mandates to Medicare and self-insured health plans.

"The way insurance benefits are designed, the costs of oral drugs are unfairly shifted to patients, so they have significant out-of-pocket costs," said Danielle Bubnis, leader of the Pennsylvania Cancer Treatment Fairness Coalition. "This would basically even the playing field."

The coalition's 19 organizations include the state pharmacists' association, the leukemia and lymphoma society, and the University of Pennsylvania Health System.

While parity laws address a glaring disparity in charges to patients, policy experts say the statutes do nothing to fix the fundamental problem: astronomical costs of new cancer drugs.

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 for the visit. In contrast, pills are covered as a pharmacy benefit, with the patient chipping in as much as 25 percent of the price.

That price keeps soaring. The average monthly cost for a branded oncology drug has doubled in the past decade to $10,000 a month, according to IMS Health, the health market analyst based in Plymouth Meeting.

"These parity laws are not bad, and they're clearly good for patients," said Penn bioethicist Steven Joffe, who is also an oncologist at Children's Hospital of Philadelphia. "But they address a symptom of the underlying problem, not the problem."

In a recent editorial in JAMA Internal Medicine, Joffe and coauthors lamented that the laws do not stop insurers from spreading the additional costs of oral drugs among all policyholders, not just cancer patients.

Moreover, the laws "sidestep the emerging national debate" about the true benefits of high-cost drugs, the authors wrote. A $100,000 drug course that cures a patient may be worth every penny; one that barely extends life or is no better than a cheaper medication may not be worth $100,000.

Patients cannot be made to wait for that debate to play out, advocates say.

"Right now, the cost of oral anticancer medications for many patients is cost-prohibitive, leaving them with fewer options for effective treatment," said Rep. Matthew Baker (R., Tioga), who sponsored the bill. "That is simply unacceptable."

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