California Governor Jerry Brown on Sept. 30 vetoed AB 1000, a bill that would have required providers of pharmacy benefits in the state to cover oral chemotherapy agents at the same cost-sharing level as intravenous (IV) or injected chemotherapy agents. The Academy had sent a letter to Brown in August urging him to take this action.
In his veto message, Brown said: “While I support the [bill] author’s efforts to make oral chemotherapy treatments more affordable for the insured, this bill doesn’t distinguish between health plans and insurers who make these drugs available at a reasonable cost and those who do not.”
Brown added that he is “concerned about the high cost of these drugs,” and would direct the state’s Department of Managed Health Care to work with the author and stakeholders to find alternative approaches to solve this problem.
AMCP noted the bill would have prohibited health insurers from charging policyholders more for covering oral chemotherapy than for intravenous chemotherapy. It also would have prohibited health plans from increasing cost-sharing for IV or injected agents in order to meet the requirements of the legislation.
“Like many patients, our members are extremely concerned about the impact that rapidly rising prescription drug costs, including costs for certain newer chemotherapy agents, have on patient access to these treatments, especially those which are clinically superior to other available treatments,” AMCP says in its Aug. 28 letter.
The Academy pointed out the risks and benefits associated with both oral and IV chemotherapy treatments.
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 regarding 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 also 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.
With the relatively recent increase in availability of oral chemotherapy agents, best practices regarding their administration are rapidly evolving. Additionally, health care professionals are collecting and analyzing “real world” data to evaluate patient adherence and outcomes associated with oral chemotherapy, AMCP noted.
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.
Finally, AMCP argued the legislation did 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,” AMCP said.
“Reduced cost-sharing does not lower the overall 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.”
To read AMCP’s Aug. 28 letter, click here or visit AMCP’s Letters, Statements and Analysis webpage at www.amcp.org/2012.