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Oral Cancer Drugs Deserve Parity

Margaret Dick Tocknell, for HealthLeaders Media, May 25, 2011

Add to that mix the proliferation of high-deductible health plans, which place more of the cost burden for medical care on enrollees, and it's no wonder sick people are forced to make tough choices.

While no one thinks it's helpful for a patient to skip medications or not comply with a treatment regimen, real solutions to this problem are lacking. With oral cancer drugs accounting for 25% to 35% of the drugs in the cancer drug pipeline this is a parity issue and it's not going away.

I reached out to several health plans to explain why benefits for oral cancer drugs are paid from pharmacy while injectable cancer drugs are part of medical benefits. The silence was deafening; I didn't even get the classic "no comment." So I turned to Susan Pisano, a spokesperson for America's Health Insurance Plans, the advocacy group for health plans. Her explanation was simple: "It's because of the way the drugs are administered. Traditionally, injectables are a medical benefit."

She said there has been discussion within the health plan industry regarding shifting oral cancer drugs to the medical benefit but not much has happened on that front. She added that the assumption that the shift would automatically lower the cost of oral cancer drugs wasn't always valid. Without being too specific, she said, "there are instances where a member would end up paying more for their drugs."

Pisano noted that health plans have taken many steps to help hold down drug costs for their members, including bulk purchasing, but at the end of the day "[you] have to wonder why a cancer drug would cost $20,000."

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1 comments on "Oral Cancer Drugs Deserve Parity"


Todd Madden (5/25/2011 at 3:44 PM)
Its the same old tired argument. Instead ranting about what health plans or more accurately, employers are covering, why not discuss the high costs of medications? And why more isn't being done to bring done costs either through other markets (Oh Canada) or through regulation. Nothing in the Unaffordable Care Act keeps the costs of drugs down. Yet legislators love to prey on the ingnorence of Americans by continuing to pressure health plans without addressing the root cause of the high costs. Good luck.