The USA currently has a funding system that treats IV cancer medications differently to oral ones. This can lead to huge differences in co-pays. In this article Tom the pharmacist explains how all this could change soon, and why that is so important for blood cancer patients. In many types of blood cancer we are increasingly being prescribed specific oral treatments rather than chemotherapy.

For US readers: This is a BIG DEAL for many blood cancer patients who take oral medications and face huge copays and deductibles!

The Cancer Drug Coverage Act (H.R. 4385) was introduced in the U.S. House by Representatives Brian Higgins (D-NY), Brett Guthrie (R-KY), Joe Morelle (D-NY), Glenn Grothman (R-WI), Doris Matsui (D-CA), and Gus Bilirakis (R-FL) on July 9, 2021.

The Act would require any group health plan that provides coverage for cancer chemotherapy treatment for oral-administered and self-injectable anticancer medications at a cost no less favorable than the cost of IV, port-administered, or injected anticancer medications. Essentially, this bill would protect the approximately 140 million patients covered by federally regulated group health plans by ending the preference for cancer care that is not administered orally.

Help other blood cancer patients and maybe yourself by reaching out to your Member in the U.S. House of Representatives and asking them to cosponsor H.R. 4385. It only takes a few minutes, and you can make a difference! Quantity matters when we ask policymakers to take action!

Please add your own story about this issue to personalize your message. Here is some info you can cut and paste. I did not ask my congressman to sponsor; he already is, but I sent him a note saying it was important to me.

As a blood cancer patient and a constituent, I am respectfully writing to request your support for the Cancer Drug Coverage Act (H.R. 4385) to ensure that every cancer patient has access to the anticancer treatments recommended by their health care provider. As you know, cancer treatment can be a trying time for patients and their families.

Traditionally, intravenous (IV) and injected treatments were the primary methods of chemotherapy delivery, which are covered under a health plan’s medical benefit where the patient is only required to pay a small office visit co-pay.

Today, oral chemotherapy has become more prevalent and is the standard of care for many types of cancer. According to a study by the National Community Oncology Dispensing Association, oral cancer treatments accounted for roughly 25% of the cancer drugs in development in 2016. Currently, an estimated 30% of treatments in development are orals.

More importantly, many oral anti-cancer medications do not have IV or injected alternatives and are the only option for some cancer patients. As these medications become more prevalent in cancer treatment, they must be as affordable as their IV counterparts.

Since oral anti-cancer medications are often covered under a health plan’s prescription benefit, many patients are responsible for extremely high and unmanageable co-pays. These co-pays range from hundreds to thousands of dollars per month, and, as a result, almost 10% of patients choose not to fill their initial prescriptions for oral anti-cancer medications due to the high rates of cost-sharing.

This bill would protect the approximately 140 million patients covered by federally regulated group health plans by ending the preference for cancer care that is not administered orally. Health insurance cost-sharing schemes should not create barriers to cancer patients’ ability to access potentially life-saving medicines.