Pharmacy Group Urges Veto of Chemotherapy Bill

The Academy of Managed Care Pharmacy (AMCP) sent a letter to California Governor Jerry Brown urging him to veto AB 1000. The bill would require providers of pharmacy benefits to cover oral chemotherapy agents at the same cost-sharing level as intravenous (IV) or injected chemotherapy agents. The legislation would apply to all health care service plan contracts renewed on or after July 1, 2013 that provide coverage of outpatient prescription drugs.

Under the bill, health insurers would not be able to charge policyholders more for covering oral chemotherapy than for intravenous chemotherapy. Health plans would not be able to increase cost-sharing for IV or injected agents in order to meet the requirements of the legislation.

“Cost-sharing parity mandates remove tools from health plans that enable them to retain the flexibility to adjust benefit design in response to the latest medical evidence for the benefit of patients,” AMCP said.

Currently, if one treatment is shown to be more effective or to have a higher clinical value, a plan can offer more favorable cost-sharing requirements for that treatment compared to other treatments. ACMP says that this flexibility offers patients coverage of more effective treatments at the most affordable rate. It also helps payers maximize the value of dollars spent on treatment.

Another consideration is the risks and benefits associated with oral and IV chemotherapy treatments. With the relatively recent increase in availability of oral chemotherapy agents, best practices about their administration are rapidly evolving.

While oral chemotherapy agents are more convenient for patients, especially those who live far away from an infusion center or physician’s office, they also place the burden of correct administration of the drug entirely on the patient or their caregiver.

There are also questions about the appropriate management of any side effects that a patient receiving oral chemotherapy may experience and how that may affect patient adherence. IV chemotherapy treatments can be less convenient for patients and can introduce the increased risk of infection, but patients are under the supervision of a health care professional who can ensure proper administration and help to manage any side effects at the time of treatment.

Finally, AMCP said, this legislation does not address the root cause of the problem: the high costs of these treatments. “Because many of the treatments that would be subject to this requirement have no generic or therapeutic alternative, it is difficult for health plans to negotiate more favorable prices from manufacturers. Reduced cost-sharing does not lower the cost of the prescription drug. Instead, it simply shifts those costs back to the health plan. This could have the unintended consequence of actually increasing costs, not only for patients receiving treatment for cancer, but for all of the patients covered by the pharmacy benefit.” For more information, visit www.amcp.org.

Last Updated 7/11/2017

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