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house Bill H.R. 1730

Should Oral Cancer Drugs be Covered at the Same Cost as Other Cancer Treatments?

Argument in favor

It doesn’t make sense for oral cancer treatments to be covered by a different part of patients’ health insurances from other cancer treatments, especially when this difference in coverage leads to big differences in cost for patients, as well. Treatment efficacy, not price, should be the deciding factor when patients are choosing between life-saving treatments.

Ellen's Opinion
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11/06/2019
Cancer is cancer. Medicine to treat cancer is medicine to treat cancer. I cannot understand why they would be covered differently.
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Francisco's Opinion
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11/06/2019
We should eliminate the Insurance industry from health! MEdicare 4 All!! Then have drug companies compete for best drugs at lowest cost universally!! Government needs to begin to represent us instead of billionaires!!
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11/06/2019
No reason to cover medicine differently based on disease. Medicine is medicine
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Argument opposed

“Oral parity” laws’ effectiveness seems to be mixed, based on available evidence. Additionally, policies like this don’t address the root cause of high healthcare costs in the U.S.: high drug prices. Rather than quibbling about how insurance covers extremely expensive drugs, it’d be a better use of Congress’s time to figure out how to make drugs more affordable, period.

jimK's Opinion
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11/06/2019
This case is an excellent argument for universal healthcare. If a drug is overpriced it will be excluded from consideration, thus eliminating the profiteering by drug companies who are pricing critical medicines, such as commonly needed insulin at higher prices simply because they can. If the market is effectively removed by a universal healthcare program, there would be an incentive to price these meds at lower, more realistic prices and with a reasonable manufacturer profit margin. Prices for meds will go up for all of the other countries with universal healthcare since they would have to bear some of the burden of needed R&D costs- which are currently paid for by US consumers since the manufacturers are free to price our meds at higher prices. I seem to recall a company that only bought out the manufacturers of unique, patent-protected life-saving drugs and then raised the prices incrementally up to 1000%-3000% of their original prices, simply because they were greedy and they could. This crap has nothing to do with R&D costs, manufacturing costs or any reasonable basis except that they were required life-saving drugs for a captive market and the new owners could charge whatever they liked. This is the kind of stuff that needs to be legislatively prevented.
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RjGoodman's Opinion
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11/06/2019
This is NOT THE ISSUE! Congress needs to work on how all healthcare is priced. As hospitals move from non-profit institutions run by local interests to for profit faculties run by venture capitalists, prices have increased dramatically, not just oral cancer drugs. You should try having dementia.
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Lesia's Opinion
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11/06/2019
So now we o my care about cancer drugs? This is bullshit. Tens of thousands of Americans die every year due to the unbridled greed of drug dealers and their insurance companies. Drug companies do very little research. We the tax payers pay for the research done at NIH while the blood suckers drain us literally to death. Single payer NOW.
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What is House Bill H.R. 1730?

This bill — the Cancer Drug Parity Act of 2019 — would require any health plan that provides coverage for cancer chemotherapy treatment to provide coverage for self administered anticancer medication at a cost no less favorable than the cost of IV, port administered, or injected anticancer medications.

Impact

Cancer patients; oral cancer treatments; cancer treatment; health insurance plans; pharmaceutical benefits; and medical benefits.

Cost of House Bill H.R. 1730

A CBO cost estimate is unavailable.

More Information

In-DepthRep. Brian Higgins (D-NY), Chair of the House Cancer Caucus, introduced this bill to require health insurance plans that cover intravenous and injectable cancer medications to also cover orally administered cancer medications at the equivalent rate:

“Innovative research has led to more effective and accessible treatment options for Cancer patients, but insurance coverage hasn’t kept pace. The Cancer Drug Parity Act, levels the costs, allowing patients and doctors, not insurance companies, to decide the best course of treatment, removing the cost discrepancy as a factor in cancer care.”

In a letter to his Congressional colleagues seeking cosponsors for this bill, Rep. Higgins expounded upon the need for this bill:

“[D]espite the fact that oral chemotherapy is popular with oncologists and patients, this legislation is needed because health insurance coverage for different types of cancer treatments often is not uniform. While intravenous treatments are usually covered under a plan’s medical benefit component, orally-administered anti-cancer medications are covered under a plan’s prescription drug component which often places a higher percentage of cost-sharing on the patient. This considerable disparity in coverage can leave cancer patients to make difficult decisions on what type of care they will receive based on the outdated guidelines of their health insurance policy, rather than the advice of their doctor. Studies have consistently shown that, when faced with high co-pays for orally administered anti-cancer drugs, some patients choose to simply not fill a prescription. Ensuring parity in coverage would both increase access to life-saving treatments and improve the quality of life for cancer patients. While America continues to set an example for the world in biomedical research, Americans will struggle to gain access to these new discoveries if insurance coverage does not keep up with the science. This legislation prepares us for the next generation of cancer treatments.”

Original cosponsor Rep. Brett Guthrie (R-KY) adds:

“Due to great innovation, many cancer treatments can now be taken orally by a patient themselves, and I believe we must ensure these patients have full access to these important drugs. Americans suffering from cancer should not have to choose between one treatment option or another based on how their insurance classifies each treatment. The Cancer Drug Parity Act will fix the discrepancy between cancer treatment drugs that are orally administered and those that are intravenously or injected and will allow patients and doctors to choose the treatment that is right and most effective for them.”

The Leukemia & Lymphoma Society is one of a number of organizations that supports this bill. Louis J. DeGennaro, Ph.D., the organization’s president and CEO, says:

“Pioneering research in precision medicine is transforming the way cancer is treated. Even with these breakthroughs, far too many cancer patients face burdensome out-of-pocket costs and cannot access their treatments because insurance rules have not kept pace with innovation. The Cancer Drug Parity Act will ensure that patients across the country experience the same cost-sharing for all cancer treatments, allowing cancer patients to have equal access to the treatments recommended by their physicians. The Leukemia & Lymphoma Society applauds Representative Higgins, Representative Guthrie, Representative Matsui and Representative Bilirakis for their leadership on behalf of cancer patients and looks forward to working with Congress to move this important bill forward.”

Oral parity’s critics argue that it doesn’t address cancer drugs’ high costs, leaving health insurers to deal with those costs by increasing premiums. However, The Leukemia and Lymphoma Society argues that this simply isn’t true, as “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.”

Some data on oral parity laws’ effectiveness suggests that legislative effects are, at best, only a partial solution. A November 2017 study by Dr. Stacie B. Dusetzina, Ph.D., of Vandervilt University School of Medicine, and colleagues found only “modest” improvement in financial protection for patients in states with parity laws. Dr. Dusetzina said, “We found really mixed results for the effectiveness of parity legislation. For most people it decreased [out of pocket] spending, but strangely it increased spending for those with the higher cost-sharing levels.”

The late Princeton health economist Uwe Reinhardt, Ph.D. and authors memorably suggested that the high cost of healthcare — including oral cancer drugs — in the U..S. is because, “It’s the prices, stupid.” In this vein, some researchers and clinicians suggest that the real answer to oral parity lies in lower oncology drug prices overall. They contend that any other efforts are just serving to shift the burden of costs to insurers, who’ll ultimately pass along increased costs along to policyholders in the form of increased premiums. America’s Health Insurance Plans (AHIP) subscribes to this view. Its director of communications, Cathryn Donaldson, says:

“We need to find ways to bring the ever-increasing prices of prescriptions under control. Health plans are committed to ensuring that patients have access to medications that are safe, effective, and affordable. However, oral-parity legislation would place an arbitrary limit on cost-sharing between medical and pharmacy benefits, forcing premiums to increase for all consumers as a result – not just those who would use oral chemotherapy.”

This bill has 33 bipartisan House cosponsors, including 17 Democrats and 16 Republicans, in the 116th Congress. A Senate version, sponsored by Sen. Tina Smith (D-MN), has nine bipartisan Senate cosponsors, including five Republicans and four Democrats.

In the 115th Congress, the House version of this bill, sponsored by Rep. Lance Leonard (R-NJ), had 175 bipartisan cosponsors, including 90 Democrats and 85 Republicans, and didn’t receive a committee vote. A Senate version, sponsored by Sen. Tina Smith (D-MN), had five bipartisan cosponsors, including three Democrats and two Republicans, and didn’t receive a committee vote.

This bill has the support of the Lymphoma Research Foundation (LRF), American Cancer Society Cancer Action Network, American Society of Hematology, American Society of Clinical Oncology, National Brain Tumor Society, Susan G. Komen, and numerous other organizations.


Of NoteNew, targeted drug therapies for cancer — many of which come in pill rather than intravenous form — have transformed a cancer diagnosis from a death sentence to a manageable chronic disease for many Americans with leukemia, lymphoma, or myeloma. For patients with certain cancers, these oral drugs are the only treatments available for their specific cancers.

Rep. Higgins’ office notes, “Oral chemotherapy is increasingly becoming a standard treatment option for cancer doctors and patients, representing approximately 35% of the oncology development pipeline. However, insurance coverage for cancer treatment has not kept up with science.” Under current law, traditional IV/injectable treatments are routinely covered under health insurance plans’ medical benefit components, whereas orally-administered anti-cancer medications are generally covered under the prescription drug component, often creating a considerable disparity in cost. As an example, in 2012, Dr. Brian Durie of the IMF wrote in the Journal of the American Society of Clinical Oncology that even though the purchase price of two myeloma medications was similar,“total cost per day was $48 higher for treatment with (injectable) vs. (oral) due to higher Medical management costs for (the injectable). The annual excess total cost of (the injectable) was $17,647.”

The Lymphoma Research Foundation (LRF) argues that this means “many patients are exposed to unmanageable cost sharing requirements in order to access oral cancer therapies.” In a The Hill op-ed, Terry Wilcox, cofounder and executive director of Patients Rising, a patient advocacy organization, adds that this also impacts cancer treatment overall:

“Due to a quirk in how Medicare and private insurance plans cover cancer drugs, chemotherapy in the preferred pill form costs patients thousands of dollars a month whereas intravenous drugs administered in a hospital or oncologist’s office may only require a small copay.”

In some cases, it’s reported that patients are even electing to forgo to delay treatment due to high out-of-pocket prices for oral treatments.

Over the past decade, 43 states have adopted their own oral parity by passing laws requiring more equitable cost-sharing for oral cancer drugs. These “oral parity laws” have a long track record of helping cancer patients without increasing premiums. However, state laws only apply to certain types of health plans, and don’t cover the approximately 60 percent of Americans on private insurance whose benefits are regulated by federal law.


Media:

Summary by Lorelei Yang

(Photo Credit: iStockphoto.com / FatCamera)

AKA

Cancer Drug Parity Act of 2019

Official Title

To amend the Public Health Service Act to require group and individual health insurance coverage and group health plans to provide for cost sharing for oral anticancer drugs on terms no less favorable than the cost sharing provided for anticancer medications administered by a health care provider.

bill Progress


  • Not enacted
    The President has not signed this bill
  • The senate has not voted
  • The house has not voted
      house Committees
      Committee on Energy and Commerce
    IntroducedMarch 13th, 2019
    Cancer is cancer. Medicine to treat cancer is medicine to treat cancer. I cannot understand why they would be covered differently.
    Like (48)
    Follow
    Share
    This case is an excellent argument for universal healthcare. If a drug is overpriced it will be excluded from consideration, thus eliminating the profiteering by drug companies who are pricing critical medicines, such as commonly needed insulin at higher prices simply because they can. If the market is effectively removed by a universal healthcare program, there would be an incentive to price these meds at lower, more realistic prices and with a reasonable manufacturer profit margin. Prices for meds will go up for all of the other countries with universal healthcare since they would have to bear some of the burden of needed R&D costs- which are currently paid for by US consumers since the manufacturers are free to price our meds at higher prices. I seem to recall a company that only bought out the manufacturers of unique, patent-protected life-saving drugs and then raised the prices incrementally up to 1000%-3000% of their original prices, simply because they were greedy and they could. This crap has nothing to do with R&D costs, manufacturing costs or any reasonable basis except that they were required life-saving drugs for a captive market and the new owners could charge whatever they liked. This is the kind of stuff that needs to be legislatively prevented.
    Like (73)
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    How about a universal single payer healthcare system? BTW, ALL drug prices are made of lies. My sisters breast cancer drug is still in trials. The company that makes it in Sweden gives it to the patients in the USA for free. The middle men of the insurance company’s up charge that free drug to 13 THOUSAND DOLLARS A MONTH. Not the manufacturer. THE BLOODSUCKER INSURANCE COMPANY. So yeah. I have no chill with the goddamn “health” insurance lies. Fuck those leeches. Profiting of the sick is immoral. All of them should be out of business.
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    This is NOT THE ISSUE! Congress needs to work on how all healthcare is priced. As hospitals move from non-profit institutions run by local interests to for profit faculties run by venture capitalists, prices have increased dramatically, not just oral cancer drugs. You should try having dementia.
    Like (29)
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    We should eliminate the Insurance industry from health! MEdicare 4 All!! Then have drug companies compete for best drugs at lowest cost universally!! Government needs to begin to represent us instead of billionaires!!
    Like (23)
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    No reason to cover medicine differently based on disease. Medicine is medicine
    Like (17)
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    Insurance companies are the death panels.
    Like (16)
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    Oral cancer medications are covered and should be covered in the same manner as other oncology medications.
    Like (11)
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    Is this a trick question? First of all, the cost for all cancer treatments should be affordable and accessible to all that need it-doesn’t matter if it’s orally taken or taken in through IV as long as it’s helping the patient get better. Hows about we work on bringing the cost down across the board of all cancer meds??
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    Nice idea, but another piecemeal step to a much broader and more basic problem that Congress refuses to debate the fundamentals of: is healthcare in the United States a privilege or a right? Until that question is decided nothing will work.
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    Not just this oral cancer treatment. ALL TREATMENTS FOR ALL DISEASES SHOULD ALL COST THE SAME NO MATTEE WHERD OR WHEN IT IS ADMINISTERED. When are we going to get leaders of this country who make laws to protect the people INSTEAD OF BIG PHARMA & MEDICAL CORPORATE.
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    Better yet, let’s get a universal healthcare system like the rest of the modern world! I support Medicare For All, giving the government the opportunity to negotiate the lowest drug prices! Medicine for people, not profit!
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    Give working Americans Medicare for all you bastards-all people deserve any and all treatment that helps them live! Break up big pharma and kill the predatory health care insurance mafia!
    Like (6)
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    So now we o my care about cancer drugs? This is bullshit. Tens of thousands of Americans die every year due to the unbridled greed of drug dealers and their insurance companies. Drug companies do very little research. We the tax payers pay for the research done at NIH while the blood suckers drain us literally to death. Single payer NOW.
    Like (6)
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    A lot of drug research is done at universities where grant money is used for R&D. A pharmaceutical company can by the drug, for a lot of money, and then bring the drug over the finish line in terms of trials. So, you are paying for the drug twice. Once with grant money, usually from NHS, and then when it is prescribed. It’s not like the universities put the money they received back into research or new grants. It’s placed back into the endowments. The market can’t correct for greed when it’s a matter of living or dying.
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    All medicine—but especially meds for life threatening illnesses—should be based on humane standards of ability to pay. The less you make, the more of a reduction or free voucher should be given to patients. Stop making a profit from diseases! Medicare for All is a human right in the first world nations with sane leaders. The USA should try being moral and compassionate to its citizenry and immigrants and having moral leaders! We might regain first world status again.
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    With a caveat though, we need some way to cut the cost of the drug overall.
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    Why would this be different then the rest. Will this bill after the votes are tallied sit on Moscow Mitch's desk like the hundreds of other bills waiting for him to sign? Pete as we watch our government being torn to shreds by your president. I ask myself what does the GOP get from this what does Pete King get from this? Would love to know From a very disappointed registered voter in your district. Ps with a very loud and proud mouth
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    I have Chronic Mylogenous Leukemia and have to take an oral chemo, the cost of 30 pills monthly is over $30,000 if I didn't have any insurance. Something needs to change because this is absolutely crazy for this medicine, that is my lifeline to be so outrageously expensive.
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    Pass universal healthcare instead.
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