Legislation that would enable cancer patients to select and pay for their best treatment option, including oral chemotherapy, has been approved by the General Assembly, according to Senator Tommy Tomlinson (R-Bucks), who was the Senate sponsor of the legislation.
Tomlinson said House Bill 60 would ensure that treatment options for patients are not limited on the basis of how the therapy is administered.
He said under current law, intravenous anti-cancer medications are typically covered under a health plan’s medical benefit, often requiring patients to pay a minimal fixed co-payment. Orally-administered anticancer medications, however, are covered under a health plan’s pharmacy benefit, making them much more costly and sometimes an unaffordable option for patients.
“Under the pharmacy benefit, oral anti-cancer medications are classified in the highest tier of a health plan’s cost-sharing system, requiring patients to pay much higher out of pocket costs for a treatment that is just as effective and often much more convenient, Tomlinson said. “This creates a huge financial barrier for patients to access the same medicine prescribed by their doctor just because it’s in an oral form.”
House Bill 60 would require health insurers to provide coverage for orally administered chemotherapy on a basis that is at least as favorable as an insured’s co-pay; coinsurance or deductibles are for intravenous or injected chemotherapy treatment.
“This legislation is intended to help cancer patients by making oral cancer drugs more affordable and accessible,” Tomlinson said. “This is important as we help cancer patients to better manage their care, especially since some oral medications can drastically reduce many side effects of treatment.”
He added that 39 states and the District of Columbia have passed these critical laws to increase access to oral oncology drugs that are crucial to patient survival.