AMCP Recommended Veto of Mass. Bill Requiring Cost Parity Between Oral and Injectable Chemotherapies

Alexandria, Va. January 15, 2013 – The Academy of Managed Care Pharmacy (AMCP) earlier this month urged Massachusetts Gov. Deval Patrick to veto a bill that would have required health plans to cover oral chemotherapy agents at the same patient cost-sharing level as intravenous (IV) or injected chemotherapy agents.

The legislation, Senate Bill 2363 – which Patrick subsequently signed into law – prohibits health insurers from charging policyholders more for covering oral chemotherapy than for intravenous chemotherapy. It also prohibits health plans from increasing cost-sharing for IV or injected agents to meet the requirements of the legislation.

Such 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.

Of utmost concern to AMCP members is ensuring that patients, including cancer patients, receive the appropriate medication for their specific disease or illness. This is achieved by designing a prescription drug benefit that balances clinical effectiveness, safety, tolerability and affordability.

Currently, if one treatment option shows more clinical effectiveness than others, a plan may choose to offer more favorable patient cost-sharing requirements for that product relative to other treatments. This benefits patients by offering coverage of more effective clinical treatments at the most affordable rates and also benefits payers by maximizing the value of dollars spent on treatment.

Reduced cost-sharing does not lower the overall cost of the prescription drug. Instead, it simply shifts those costs back to the health plan and ultimately the employers served by the plans. This could have the unintended consequence of raising costs for the state and for employers, thus increasing the overall cost of health care.

Finally, this legislation does not address the root cause of the problem: the high costs of these treatments. Many medications subject to this requirement have no generic or therapeutic alternatives; therefore, it is difficult for health plans to negotiate more favorable prices from manufacturers. Furthermore, this legislation assumes that oral forms of chemotherapy agents with injectable equivalents are less expensive, which is not always the case.

To read AMCP’s Jan. 3, 2013, letter to Gov. Patrick, click here