Oral Chemotherapy Fairness

Currently in Idaho, all state regulated (not self-funded) health plans currently impose a disproportionate cost-share between traditional (intravenous) chemotherapies and oral based chemotherapies. The dramatic cost associated with oral chemotherapies often prohibits patients from receiving treatment or following the course of treatment prescribed by their physician.

Traditional chemotherapies are typically covered under an insurance plan’s medical or major medical benefit and typically brings with it a traditional copay, consistent with an average patient’s financial expectation. Oral chemotherapies are classified under an insurance plan’s pharmaceutical benefit and with it brings significant coinsurance that is typically unanticipated and very costly.

The use of coinsurance means that patients are required to pay a percentage of the cost of the medication. In Idaho, for specialty medications, 74 of 74 silver plans use coinsurance and the average coinsurance for these medications is 33%. This can mean thousands of dollars per prescription per month.

States that have enacted chemotherapy fairness laws have ensured that cancer patients have parity in treatment, and thus, fewer barriers to the best course of treatment prescribed by their physician.  Furthermore, oral chemotherapies can be delivered at home, providing access to treatment for cancer patients across the state, many of whom live a significant distance from a regional cancer treatment clinic.