NC Cancer Treatment Fairness Act

NC Cancer Treatment Fairness Act

The NC Cancer Treatment Fairness Act would require that insurers that provide coverage for both IV AND oral chemotherapies must provide the coverage for oral chemotherapies on a basis no less favorable than coverage for IV treatment, including patients’ out of pocket (OOP) costs. 

Chemotherapy is a critical component of cancer treatment, however many insurance plans cover intravenous (IV) chemotherapies, a medical benefit, differently than oral chemotherapies, a pharmacy benefit. This historical distinction in plan benefits preceded the development of oral chemotherapies.  The cost disparity between oral cancer medications and IV medications creates a significant barrier for cancer patients to access essential life saving oral chemotherapy medication.

 About Oral Chemotherapy Treatment

• Often there are no substitutes for oral chemotherapy.  If patients cannot afford the OOP expense for these therapies, they may not receive any other treatments.

• Oral anti-cancer products are the future of cancer treatment.  In 2014, half of all FDA-approved oncological treatments are oral medications.[i]  Patients should not be penalized simply because insurance laws have not kept pace with modern medicine.

• Oral anti-cancer treatments are not inherently more costly than IV treatments.  For metastatic breast cancer patients, the cost of oral chemotherapy is $35,842 annually compared to $43,353 for IV chemotherapy.[ii]

• Unlike many IV chemotherapies, oral treatments are targeted agents that attack only the cancer cells.  Patients receiving these oral treatments often experience fewer severe side effects, they can avoid burdensome medical visits, and they and their caretaker can avoid missing time from work. 

Benefits of Oral Anti-cancer Products to Patients

• Oral anti-cancer treatment can be a smart way to ensure that patients have affordable access to the care they need.  By undergoing a form of treatment that does not require extensive office visits or nursing staff supervision, oral anti-cancer treatments can be taken with greater ease than IV treatments.

• Medical visits for patients with colon cancer taking an oral medication revealed an average of eight provider visits as compared to 30 visits for patients using an IV alternative.  The fewer visits lessen the strain on the health care system and can provide for a better quality of life for the patient and his or her family.

• By administering care in the home, oral anti-cancer treatments can save on transportation costs, which is a particular concern for patients in rural settings or those without adequate support networks.

• IV treatment is a recognized and critical part of cancer care, however oral anti-cancer products offer an important alternative that can keep patients healthy.  Patients need access to appropriate treatment that is affordable and accessible, regardless of how it is administered.

Oral Anti-Cancer Legislation

• To date, 42 states (most recently Arizona and Kentucky) and the District of Columbia have enacted oral anti-cancer coverage legislation. 

• Opponents have argued that this type of coverage will increase insurance premiums, but the evidence does not support this assertion. No states have amended their laws due to premium cost increases, no efforts have been made to repeal these laws.
  • Oregon found that the impact to plans was minimal with only nine out of 79 plans citing any impact on premiums; the impact was “very minimal”.
  • The Texas Department of Insurance conducted a cost review before legislation was passed in that state that found that the estimated cost of implementing coverage for oral anti-cancer medications would be less than $0.50 per member per month[iv].  There have been no subsequent allegations of premium increase due to passage of this legislation.
  • 13 other states conducted similar studies and found this legislation had zero to negligible impact on premiums.

Cancer in North Carolina

• In 2012 (the most recent year for which data are available), more than 51,000 North Carolinians were diagnosed with cancer.  In the same year, more than 18,000 lost their battle with the disease. 1 in 25 North Carolinians is a cancer survivor.

• Cancer is the leading cause of death in North Carolina. Lung cancer accounts for the most cancer deaths, followed by colorectal, breast, and prostate cancers.  1 in 25 North Carolinians is a survivor.