Oral Parity
many physicians were unaware that their patient
opted out of filling a prescription for an OAM be-
cause of cost, she added.
“This study provided important data that are
missing from most other studies [on] how often
people are leaving their drugs behind,” commented
Stacie B. Dusetzina, PhD, from Vanderbilt Uni-
versity School of Medicine in Nashville. Her own
research on the impact of parity legislation on OOP
expenses was not able to consider individuals who
abandoned their prescriptions due to costs.
“When the standard treatments were all
intravenously administered, they were covered by
insurance, but now we have a group of standard
treatments that are not being covered and also
present some difficulties in terms of adherence and
compliance,” said Jonathan W. Friedberg, MD,
MMSc, from the University of Rochester Medi-
cal Center in New York. Dr. Friedberg recently
co-chaired a Lymphoma Research Foundation
workshop on the complexities and challenges of
adherence to oral therapies in lymphoid malignan-
cies. For more about the epidemiology of non-
adherence to OAMs, see SIDEBAR 1 .
Oral-Parity Disparity
Forty-three states plus the District of Columbia have
passed oral-parity legislation to limit patient OOP
costs for OAMs, and a number of other states have
similar legislation on the agenda. (See the “Oral Anti-
Cancer Therapy Access Legislative Landscape” map.)
State parity laws, however, only apply to certain
commercial health insurance plans, including those
that are purchased by small groups and individu-
als. Self-funded patients, patients covered by health
plans that fall under the federal ERISA law (usually
large, multi-state health plans), or those covered
by Medicare and other federally funded insurance
plans are not
Oral Anti-Cancer Therapy Access Legislative Landscape - 2018
eligible. Estimates
vary from state to
state, but it’s pos-
sible that only half
of all U.S. patients
are protected. 3
“The state
parity laws are
not a silver
bullet,” warned
Marialanna Lee,
senior director of
state government
affairs at the Leu-
kemia & Lym-
phoma Society
(LLS). “There are
many different
insurance plan
designs out there.
These laws are tailored to address one feature of
provide for cost-sharing for oral anti-cancer drugs
benefits design – which we saw was presenting
on terms no less favorable than the cost-sharing
problems years ago.”
provided for anti-cancer medications administered
“The momentum that cancer advocates have
by a health-care provider.”
built by passing so many successful state laws has
Companion legislation in the Senate hit a wall
made a profound impact on Capitol Hill, and I think when its two sponsors both left their posts. Sen.
oral parity is one of the few health-care issues that
Mark Kirk (R-IL) lost his seat in the November
has a chance to get across the finish line this Con-
election and Sen. Al Franken (D-MN) resigned in
gress,” said Brian Connell, senior director of federal
January 2018.
affairs at LLS.
Mr. Connell told ASH Clinical News that signifi-
In March 2017, Reps. Leonard Lance (R-NJ)
cant progress has been made in advancing federal
and Brian Higgins (D-NY) introduced the Cancer
oral parity in the current Congress. The bill has
Drug Parity Act (H.R. 1409), which has a biparti-
wide bipartisan support in the House and several
san list of 151 cosponsors – 75 Democrats and 76
members of the Senate have reached out to cancer
Republicans. 4 The bill seeks to “amend the Public
advocates offering to help lead the oral-parity effort
in the coming months.
Health Service Act to require group and individual
“This legislation is not trying to solve all our
health insurance coverage and group health plans to
SIDEBAR 1
Adherence in Oral Therapies
Oral anti-cancer medications (OAMs) present some dis-
tinct challenges to hematologist-oncologists accustomed
to prescribing infused anti-cancer drugs. First, unlike
most other specialists, they’re not used to patients skip-
ping their meds.
“With chemotherapy, we are actively administering
the drugs in clinic for a defined period of time, so we know
exactly what patients are getting,” Jonathan Friedberg,
MD, MMSc, told ASH Clinical News.
“With infused drugs, patients generally are assessed
before each treatment, so we understand much more
what is happening with them and we can assess whether
they are fit for treatment,” Dr. Friedberg explained.
“But with the oral drugs, we send patients home with a
prescription and we don’t know exactly what the patients
are taking, if they’re taking them in the way prescribed,
or even if they are taking them at all.”
In October 2017, Dr. Friedberg and Michael E. Williams,
MD, ScM, from the University of Virginia Cancer Center, co-
chaired the Lymphoma Research Foundation’s “Adherence
and Oral Therapies in Lymphoma and CLL Workshop,”
whi