Summary

4/26/2013--Introduced. Cancer Drug Coverage Parity Act of 2013 - Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue... Read More

Status

This bill was introduced on Apr 26, 2013, in a previous session of Congress, but was not passed.

Date Introduced
Apr 26, 2013

Co-Sponsors

d-76
r-15

Bill Text

A BILL

To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans to provide for coverage of oral anticancer drugs on terms no less favorable than the coverage provided for anticancer medications administered by a health care provider.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Cancer Drug Coverage Parity Act of 2013''.

SEC. 2. PARITY IN COVERAGE FOR ORAL ANTICANCER DRUGS.

(a) Employee Retirement Income Security Act of 1974 Amendments.-- (1) Subpart B of part 7 of subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding at the end the following new section:

``SEC. 716. PARITY IN COVERAGE FOR ORAL ANTICANCER DRUGS.

``(a) In General.--Subject to subsection (b), a group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, that provides benefits with respect to anticancer medications administered by a health care provider shall provide for no less favorable coverage for prescribed, patient-administered anticancer medications that are used to kill, slow, or prevent the growth of cancerous cells and that have been approved by the Food and Drug Administration. ``(b) Limitation.--Subsection (a) shall only apply to an anticancer medication that is prescribed based on a finding by...

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Sentiment Map

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Nation

71 Supporting
11 Opposing
87% 13%

State: CA

11 Supporting
2 Opposing
85% 15%

District: 1st

1 Supporting
0 Opposing
100% 0%

Popularity Trend

Organizations Supporting

There are very few therapies available for brain tumor patients. One type of chemotherapy, temozolomide (Temodar) is a widely used treatment, and often the standard of care, for many patients with malignant brain tumors. Temozolomide is almost exclusively prescribed orally, and there are few (and sometime no) alternative therapies. The Problem Many health insurance plans cover temozolomide as a pharmacy benefit and not as a medical benefit, as traditional IV chemotherapy is covered. The result can be high co-pays or co-insurance in the hundreds or even thousands of extra dollars per month. An increasing number of brain tumor patients are reporting that they cannot afford the out-of-pocket costs per month to access temozolomide, yet they must take this medicine as part of their oncologist-prescribed brain tumor treatment. For many brain tumor patients there is not an IV chemotherapy substitute. Thus, health insurance cost-sharing can create real economic hardships and present a barrier to the affordability of a medically necessary chemotherapy regimen. Additionally, research has found that more than 25 percent of all anticancer agents currently in development are planned as oral drugs. Many of these new oral drugs have shown significant clinical advantages over traditional IV/injected forms of cancer treatment in early trials. As new treatments come into the marketplace, the lack of oral chemotherapy parity will become an even larger problem, both for patients as well as the pharmaceutical industry. The Solution Congress should support oral chemotherapy parity legislation. The Cancer Drug Coverage Parity Act (HR 1801) and The Cancer Treatment Parity Act (S. 1879) are both supported by a bi-partisan group of co-sponsors, and would require health plans that cover chemotherapy to cover oral chemotherapy on an equal basis as chemotherapy given through hospital administered IV or injection. Not only is access to oral chemotherapy critical to proper care, it can be beneficial to the patient’s quality of life because he or she can undergo treatment at home instead of traveling to a hospital. Health insurance should facilitate brain tumor treatment, and not create a financial barrier to it. http://www.braintumor.org/advocate-for-change/legislative-agenda/oral-chemotherapy-parity/

Although there are a number of variables that go into choosing an anti-cancer medication, financial costs to a patient with cancer coverage should not play into which treatment a patient chooses or even can access. This bill would give patients better access to a greater number of cancer treatments.

AIM at Melanoma 1 year ago

The bill ensures that patients will have access to state-of-the-art treatments that will most effectively save and extend their lives. Moreover, the bill puts the decision making where it belongs- in the hands of the treating physician- who is best equipped to determine what is in the best interest of the patient while limiting out of pocket costs for patients.

Intravenous (IV) and injectable therapeutics administered by a physician were once the primary modes of cancer treatment. However, innovative patient-administered medicines have become more prevalent and are now the recognized standard of care for many types of cancers. Approximately one-quarter of all cancer drugs under development are oral, or other patient-administered treatments, and there is an increasing trend toward development of these therapies. LLS supports state and federal efforts to bring parity among cancer drug coverage requirements – regardless of setting, mode of delivery or who administers the treatment.

The IMF believes that all cancer patients should have access to the treatment recommended by their physicians and should not suffer from cost discrimination based on the type of therapy provided or the mechanism for the delivery of that therapy.

Insurance coverage has not kept pace with innovation in medicine and the growing trend towards orally administered chemotherapy. 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. Oral chemotherapy also accounts for approximately 35% of the oncology development pipeline. 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 can be hundreds or 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. The Cancer Drug Coverage Parity Act requires 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. This bill ensures equality of access and insurance coverage for ALL anti-cancer regimens. Health insurance cost-sharing schemes should not create barriers to cancer patients’ ability to access potentially life-saving medicines.

Organizations Opposing

No organizations opposing yet.

Users Supporting

I support H.R. 1801: Cancer Drug Coverage Parity Act of 2013 because...my mother was diagnosed with stomache cancer in October of 2011. She had the tumor removed but was prescribed an anticancer medication called Gleevac that costs $6,000 per month. Her doctor recommended she take the medication for 3 years. Even with a discount her pharmacy gave her it still would have cost us $3,800 per month out of pocket. We could not afford the medication. We were devastated to think that there was a medication that could permit her to fight her cancer and live longer, but we were not going to be able to pay for it. We immediatly began preparing for the worst. Fortunatley because she is on a fixed income of $1,200 per month social security combined with my father, she was awarded a grant through her insurance company. She has been taking the medication since then and is now in remission. Without that grant, we would have lost her, since her doctor had told us that without the medication the tumor most likley would grow back within a year and a half. But she is alive and well. She has her ups and downs, but we are so thankful that she has been able to be with us just a little while longer.

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CA
29
raquelirn
CA-29
1 year ago

I support H.R. 1801: Cancer Drug Coverage Parity Act of 2013 because I have chronic lymphocytic leukemia (CLL). The new oral cancer drugs give people like myself a chance to live longer without the negative effects that occur with years of taking traditional chemotherapeutic drugs, most notably chemo brain and quality of life issues. And like most CLL patients I know, I could not afford the high cost of these new drugs. Please pass H.R. 1801 quickly. Thank you.

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NY
25
Anonymous1801183
NY-25
1 year ago

Users Opposing

No constituents opposing yet.

Bill Summary

<br /> 4/26/2013--Introduced.<br /> Cancer Drug Coverage Parity Act of 2013 - Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to require a group or individual health plan providing benefits with respect to anticancer medications administered by a health care provider to provide no less favorable coverage for prescribed, patient-administered anticancer medications used to kill, slow, or prevent the growth of cancerous cells and that have been approved by the Food and Drug Administration (FDA). Applies such requirement to medication that is prescribed based on a finding by the treating physician that the medication is: (1) medically necessary for the purpose of killing, slowing, or preventing the growth of cancerous cells in accordance with nationally accepted standards of medical practice; and (2) clinically appropriate in terms of type, frequency, extent site, and duration. Permits such coverage to be subject to the same cost-sharing applicable to anticancer medications administered by a health care provider under the plan. Prohibits a health plan from imposing an increase in out-of-pocket costs, reclassifying benefits with respect to anticancer medications, or applying more restrictive limitations on prescribed orally- or intravenously-administered or injected anticancer medications. Requires a plan to provide notice to each participant and beneficiary regarding the coverage required under this Act. Prohibits a health plan from taking specified actions to avoid the requirements of this Act. Requires the Medicare Payment Advisory Commission to assess how closing the Medicare part D donut hole affects Medicare coverage for orally-administered anticancer medications, with a particular focus on cost and accessibility.<br /> <br />

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