New Jersey cancer patients will get the same health insurance coverage for oral cancer drugs sold as prescription medications and taken in their own homes as they now get for chemotherapy drugs delivered intravenously at healthcare facilities under legislation signed Tuesday by Gov. Chris Christie.
The American Cancer Society of New York and New Jersey said pricing parity for oral and injected cancer drugs will encourage patients to use the most appropriate drug without being influenced by their out-of-pocket costs.
Some cancer patients have faced hundreds of dollars a month in oral cancer drug bills depending on their description drug plan, said Blair Horner, vice president of advocacy for the cancer society.
The new law requires health insurers to cover orally administered cancer medications on a basis that is no less favorable than the terms that apply to injected anti-cancer medications. Insurers are prohibited from subjecting oral cancer drugs to any prior authorization, dollar limits, co-payments, deductibles, or coinsurance standards that don't apply to intravenously-administered or injected drugs.
"Medical research over the past decade has provided cancer patients with alternatives to the traditional intravenous and injected cancer drugs," said bill co-sponsor Sen. Loretta Weinberg (D-Bergen). "It is imperative that we update our laws."
But Ward Sanders, president of the New Jersey Association of Health Plans, pointed out that the law didn't address the underlying issue of the high cost of prescription drugs.
"Some patients who need or choose oral chemotherapy drugs rather than traditional intravenous chemotherapy have faced real difficulty affording their medications, because some pharmaceutical companies have priced the drugs so high that they are out of reach," he said. "Unfortunately, this law fails to address the high prices of these drugs and rather, benefits only about 30 percent of New Jerseyans with certain types of insurance. This law is a missed opportunity to more broadly assist consumers who need access to care."
A quarter of the nearly 500 cancer drugs now in the research pipeline will be oral medications, Hormer said. "Many new chemotherapy drugs come in pill form that patients can take at home, rather than intravenous injections administered at a medical facility. In New Jersey, there can be a big difference in the coverage insurance companies provide for orally administered medications versus coverage for intravenous treatments. Advancements in cancer treatments are useless if patients don't have access to or can't afford them."
Horner said the cost differential results because the intravenous cancer drug is covered by the health plan as part of the medical coverage for treating cancer. But the oral chemotherapy drug usually falls under the patient's prescription drug plan, and depending on the plan, the individual may be required to pay a significant share of that cost.
"It is not true for every [health] plan, but patients who rely on oral cancer drugs can face [significant] out-of-pocket costs – so much so that they may choose not to have the therapy, which could affect their health," Horner said. Fourteen states, including New York, have passed cancer drug parity laws.
"Oral chemotherapy is truly the wave of the future in cancer care," the American Cancer Society said in written testimony to the legislature. "Oral treatments offer patients distinct advantages over traditional intravenous chemotherapy, including the fact that they are targeted therapies which attack only the cancer cells, leaving healthy cells alone. There is no scientific or medical rationale for categorizing orally-administered drugs differently than IV drugs."
Dean J. Paranicas, chief executive of the HealthCare Institute of New Jersey, whose members are drug research and development firms, said the law gives patients "access to the medications that their doctor feels is most appropriate" and will "provide another treatment option when deciding on a therapeutic course of action to fight this deadly disease."