Congressman Brian Higgins, NY-26, announced today that he has introduced the Cancer Drug Coverage Parity Act (H.R. 1801), which would require health insurance companies to equally cover and reimburse intravenous/injectable and orally administered anti-cancer medication.
"Doctors, not insurance companies, should decide the best course of treatment for cancer patients," said Higgins, a member of the House Cancer Caucus. "This legislation will better enable patients to have access to the best available treatments that will extend and improve their quality of life."
Under current law, most IV treatments are routinely covered under the medical benefit component of a health insurance plan, while orally administered anti-cancer medications are usually covered under the prescription drug component, which often results in a considerable disparity in coverage. This legislation would remove this disparity, ensuring that medication cost is not a factor in patient decisions. This is especially important as oral chemotherapy is becoming a more common standard of care for cancer patients and many of these oral chemotherapy drugs do not have IV/injectable equivalents.
"On behalf of Roswell Park and its patients, I want to thank Congressman Higgins for advocating for fair, reasonable access to life-saving medications," said Dr. Eunice Wang, a medical oncologist at Roswell Park Cancer Institute. "It is imperative that treatment decisions be based on medical evidence and not dictated by insurance policies. It is critical that our payment policies and systems keep up with the innovations in drug development."
"Thankfully, the New York State Assembly passed a similar state law, effective Jan. 1, 2012, which covers about half of all cancer patients in the state," said Nancy Hails, executive director of The Western & Central NY Chapter Leukemia & Lymphoma Society. "We are hopeful that HR 1801, when passed, will level the playing field, and ensure access to life-saving therapies for all of our patients."
"Every day we hear stories from patients that can't afford the treatment that has been recommended by their physician because of high out-of-pocket costs. This bill will mean that patients no longer have to decide between the best treatment and financial stability, and can focus on what really matters: beating their cancer. PEAC members and their advocates applaud Congressman Higgins for his leadership and will passionately work beside him for the passage of this critical legislation this Congress," said Meghan Buzby, director of U.S. advocacy for the International Myeloma Foundation, and steering committee member of the Patients Equal Access Coalition, a patient-focused coalition of organizations representing patients, health care professionals, care centers, and industry that advocates for patients to have equal access to all anticancer treatments.
"The Cancer Drug Coverage Parity Act is important legislation that would help alleviate the serious financial burden that patients with blood cancer currently face in order to take life-saving therapies," said American Society of Hematology President Dr. Janis L. Abkowitz, of the University of Washington. "The American Society of Hematology commends Rep. Higgins on his efforts with this bipartisan legislation that will help improve patient access to affordable oral therapies for their cancer."
Last week, Higgins spoke on the Floor of the House of Representatives about this legislation.
The text of Higgins' remarks is below:
"Mr. Speaker, America's biomedical research industry is the envy of the world, but the health insurance model isn't keeping pace with the science.
"For cancer patients, this means that smart drugs purchased at a pharmacy and self-administered orally are dramatically more expensive than traditional chemotherapy administered at a hospital or a clinic.
"This makes no sense. That is why I have joined with a broad coalition of the cancer community to re-introduce the Cancer Drug Coverage Parity Act. This bill would require health insurance coverage for smart drugs and injectable treatments at the same rate.
"Ensuring that parity in coverage exists would both increase access to life-saving treatments and improve quality of life for cancer patients.
"Mr. Speaker, a cancer patient should never be denied the most effective cancer treatment because of cost. We make sure that coverage for cancer treatments keep pace with the promising new therapies as they become available."
Higgins introduced this legislation with 16 bipartisan cosponsors and the support of numerous organizations, including: AIM at Melanoma, Alliance of Dedicated Cancer Centers, American Society of Hematology, Aplastic Anemia and MDS International Foundation, Association of American Cancer Institutes, Association of Community Cancer Centers, Astellas Pharma US, Bayer Healthcare, Bioscrip, Celgene, Community Oncology Alliance, Facing Our Risk of Cancer Empowered (FORCE), Fight Colorectal Cancer, Genentech, Glaxo Smith Kline, Hematology-Oncology Pharmacy Association, International Myeloma Foundation, Leukemia and Lymphoma Society, Lymphoma Research Foundation, Millenium: The Takeda Oncology Company, National Brain Tumor Society, National Patient Advocate Foundation, Oncology Nursing Society, Ovarian Cancer National Alliance, Patients Equal Access Coalition, Roswell Park Cancer Institute, Susan G. Komen for the Cure Advocacy Alliance, The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Richard J. Solove Institute, Zero - The End of Prostate Cancer.