Policy Archive

Support Equitable Coverage of Oral Chemotherapy

As science and technology advance, more cancer treatments are available orally. Oral chemotherapy is now the standard of care for many types of cancer and accounts for about a third of the oncology development pipeline. Importantly, many cancer therapies taken by mouth do not have IV or injected alternatives, and are the only option for some patients. Act Now to ask your lawmakers to support the Cancer Drug Coverage Parity Act, federal legislation that will ensure equal insurance coverage of cancer treatments regardless of how they are administered.

The Cancer Drug Coverage Parity Act requires private health plans that provide coverage for chemotherapy to also cover oral, self-administered anticancer medication at a cost similar to that of IV, port administered or injected cancer medications. Patients who receive intravenously administered therapies, covered under an insurance plan's medical benefit, are responsible only for a copayment for each office visit. Conversely, oral chemotherapy is often covered under an insurer's pharmacy benefit, resulting in substantially higher out-of-pocket costs and a significant financial burden for many patients.

While oral treatment may be easier than taking a trip to the infusion clinic, the pills are just as strong as IV chemotherapy. Many of these oral therapies target specific biologic processes in cancer cells and block cancer cell growth. In addition to having less toxicity and fewer side effects, oral therapies are convenient, especially for patients who must travel long distances to their treatment facility.

Outdated insurance coverage policies have not kept pace with medical innovation and the growing trend toward orally administered chemotherapy. Every person diagnosed with cancer should have affordable access to the evidence-based treatments recommended by their healthcare team, and should not be subject to cost discrimination due to the delivery mechanism of the therapy.

FORCE is supporting state-level efforts to address this issue in addition to the national legislative initiative. Forty-three states and the District of Columbia now have oral cancer treatment fairness laws, ensuring that cancer patients have equal access to oral anticancer medications.