New Oral Oncology Parity Laws

Has anyone heard of the new Oral Oncology Parity Laws? Apparently there are now 34 states who have passed bills to get non-Medicare insurance companies to comply with keeping the cost of oral chemotherapy pills on a parity with IV chemo delivered at a doctor's office or clinic. Most insurances will cover IV chemo under the major medical portion of the plan so the patient pays a copay and/or coinsurance only. Oral chemo prescriptions though are charged through the pharmacy plan of most insurance companies and those costs can run into thousands of dollars per month for the patient's portion.

The new Oral Oncology Parity Laws state that if the insurance company plan provides coverage for IV chemotherapy services in a clinic or hospital, it must also provide oral chemotherapy at a similar cost parity. Most of the new state bills indicate the maximum monthly cost to the patient for oral chemotherapy prescriptions can be no higher than $75 / month. I learned that my state of Missouri has passed such a bill which just became effective Jan 1, 2015. I am attaching some links here to general information about the parity laws and a copy of the wording from the actual Missouri bill. Language and enforcement may vary by state.

It will be very interesting to see how the insurance companies will work around this. My guess is there may be more expensive chemo drugs "excluded" from their formularies or there will be further increases in premiums, deductibles and out of pocket limits. Hopefully this is a legal trend that will help to curb the exorbitant pricing of cancer drugs!

http://speac.myeloma.org/wp-content/uploads/2014/08/OralOncologyParityOnePageFactSheet_August2014.pdf

http://themissouritimes.com/8956/press-release-gov-nixon-signs-bill-ensure-affordable-access-oral-chemotherapy/

http://legiscan.com/MO/text/SB668/id/983931/Missou...