Posted 8/12/2017 2:36 AM (GMT 0)
Just to clarify, for most States the reference is to a " Cancer Treatment Fairness Act", which "would require that insurers that provide coverage for both IV AND oral chemotherapies must provide the coverage for oral chemotherapies on a basis no less favorable than coverage for IV treatment, including patients’ out of pocket (OOP) costs."
The common Rationale is:
"Chemotherapy is a critical component of cancer treatment, however many insurance plans cover intravenous (IV) chemotherapies, a medical benefit, differently than oral chemotherapies, a pharmacy benefit. This historical distinction in plan benefits preceded the development of oral chemotherapies. The cost disparity between oral cancer medications and IV medications creates a significant barrier for cancer patients to access essential life saving oral chemotherapy medication."
For some older treatments where there are readily available, FDA approved IV or oral choices for the same thing, e.g. capecitabine chemotherapy in first-line metastatic breast, it should be a no brainer.
For more recently approved drugs, where there may still be issues of the manner of delivery, sequencing, medical observation during administration, etc., there may still be kinks to work out with those things vs. Insurance companies reimbursements between IV treatments vs. oral pharmacy drugs.
I'm on oral Xtandi, and I don't think the Act applies.
Zytiga is also oral, and I don't think the Act applies there, either.
I think another route could be to explore the Drug Formulary and any Prior Approval requirements for treatments/drugs options on your Insurance plan(s).
Charles