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Analysis of Marketplace Cancer Drug Coverage Reveals Transparency and Cost Barriers
ACS CAN Makes Policy Recommendations to Ensure Cancer Patients Understand Coverage Options and Have Access to Affordable Care
November 18, 2015
WASHINGTON, D.C. November 18, 2015 Patients with health coverage bought through one of the marketplaces created under the Affordable Care Act (ACA) continue to face challenges finding out which cancer drugs are covered by their plan and at what cost, according to a new analysis by the American Cancer Society Cancer Action Network (ACS CAN). The analysis of 2015 marketplace formularies in six states California, Florida, Illinois, North Carolina, Texas and Washington -- is an update to a 2014 report from ACS CAN and part of a comprehensive effort to ensure that the ACA 's patient protections work as intended for people with cancer. Having access to accurate, up-to-date prescription information is imperative for cancer patients, survivors and their loved ones as they work to make informed decisions about the best health coverage for them and their families, said Chris Hansen, president of ACS CAN, the advocacy affiliate of the American Cancer Society. Cancer patients should not have to struggle to understand their plan options, or worse, risk choosing a plan that doesn 't meet their needs based on inaccurate or inadequate information. The six states analyzed cover nearly half of all marketplace enrollees nationwide. The report includes several important findings, including:
- Transparency issues remain a factor for patients Getting information about a plan 's drug formulary can be challenging, and we found inconsistencies in cost-sharing information.
- Patient cost-sharing remains high Marketplace plans tend to place cancer drugs on their highest tier, and many require patients to pay coinsurance as opposed to a flat copay.
- Patients frequently face coverage limits Limits on coverage of the cancer drugs we analyzed, such as prior authorization, step therapy, and quantity limits, are frequently applied.
The analysis includes ACS CAN 's policy recommendations to states and the HHS to increase transparency of coverage and cost-sharing, ensure adequate access to medically necessary drugs via an exceptions process, make cost-sharing more predictable and affordable for patients, and monitor the marketplace for evidence of discrimination against persons with high-cost conditions such as cancer. As treatments and therapies continue to reflect increased understanding of cancer at the molecular level, it is imperative that health plans design and communicate their benefits in a way that ensures adequate, timely, and affordable access to prescription drugs that are necessary reduce death and suffering from cancer, Hansen said. In 2015, an estimated 1.7 million Americans are expected to be diagnosed with cancer, and approximately 14.5 million Americans with a history of cancer were alive on January 1, 2014. ACS CAN, the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society, supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer with the training and tools they need to make their voices heard. For more information, visit www.fightcancer.org. FOR MORE INFORMATION, CONTACT: Alissa Crispino or Steven Weiss American Cancer Society Cancer Action Network Phone: (202) 661-5772 or (202) 661-5711 Email: [email protected] or [email protected] #acscan #cancer #aca #marketplace #drugformulary
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