Increasing Patient Access through Oral Parity Legislation

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1 Increasing Patient Access through Oral Parity Legislation

2 The Leukemia & Lymphoma Society A powerhouse among nonprofits searching for cancer cures Our Mission; Cure leukemia, lymphoma, Hodgkin s disease and myeloma, and improve the quality of life of patients and their families Every four minutes, someone is diagnosed and every 10 minutes, someone dies more than 53,010 in 2011

3 What we do Provide Information to help patients access the best treatment for their specific blood cancer through: Our Information Resource Center ( ) staffed by specialists who answer questions and provide resources in more than 165 languages. We can also link patients to the most up-to-date clinical trials and community resources. Our Web site delivers education, support and resources National education Webcasts and telephone workshops with blood cancer medical experts. Educational materials free for patients and health care professional

4 Giving Patients And Families What They Need, At No Cost Services based in local communities Massachusetts Chapter serves MA, ME & NH. To date we have had over 2100 inquires locally from patients, families and HCP s Educational programs featuring experts on blood cancers and their treatments, new developments, clinical trials and common issues faced by patients and families. Over 850 participants since July 2011 Support programs to help patients with emotional, social and job-related aspects of coping with cancer -8 local support groups Financial Aid - A stipend of $100 is available to help with various transportation, drugs and treatment costs not covered by insurance. 710,000 this year Co-Pay Assistance Program helps eligible patients cover prescription drug co-pays and health insurance premiums

5 LLS Advocates nationally and locally for legislation that will improve the quality of life of patients and their families LLS works to: Ensure effective, federally-funded biomedical research Enhance the quality of cancer care Educate and mobilize volunteers to take action Provide access to the myriad of treatments available LLS supports public policy initiatives federally and locally including Oral Parity Legislation in MA, NH & ME

6 Patient Access: Issue Background Historically, oncology treatment has been administered intravenously (IV) in a physician s office. However, as innovation has continued to evolve, oral therapies represent an increasing number of prescribed oncolytics. Intravenous (IV) cancer medications are typically covered under a health plan s medical benefit. In this situation, patients are usually required to pay an office visit copayment and are not required to pay a separate fee for the drug.

7 Issue Background (cont d) Orally administered cancer medications are typically covered under a health plan s pharmacy benefit, and some plans require patients to pay high out of pocket copays to fill these prescriptions (avg OOP in 2009: $2942, up 17% from 2008). Unfortunately, insurance benefit design has not kept up with medical innovation which has created a major barrier for patients that need access to life-saving treatments. It is estimated that 25-35% of the medications in the oncology development pipeline are oral therapies.

8 Issue Background (cont d) High out-of-pocket costs for treatment places financial hardship many cancer patients. When confronted with this reality, some choose to forgo treatment or make their treatment choice based on cost rather efficacy A new study found that 10% of patients did NOT fill their initial prescriptions for oral anti-cancer medications due to high rates of costsharing There are no intravenous substitutes for many oral chemotherapy drugs. Patients affected by this issue include multiple myeloma, leukemia, lymphoma, breast, kidney, lung and brain cancer patients.

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10 Common Myths Debunked Oral chemotherapy is more expensive than IV The number of visits for initial care follow-ups and potential complications is substantially fewer for oral chemotherapy than for IV chemotherapy. 10 % of the cost for IV chemotherapy drugs comes from administrative expenses including the nurse and doctor s time. Other issues to take into consideration: time off work to get infusions, possible temporary disability, long term medical cost associated with side effects of IV chemotherapy

11 Common Myths Debunked Mandate? This bill is NOT a mandate! It does NOT require health plans to cover chemotherapy. It simply says that if a plan covers cancer treatment, then it must cover oral and IV or injectables at an equal reimbursement rate. Oral chemotherapy parity will increase premiums Studies conducted in states that have oral chemotherapy parity laws such as Vermont, Texas, and Indiana have concluded that any raises in health insurance premiums would be negligible

12 Conclusion Access to oral anti-cancer medications is - and will continue to be - a growing problem in the cancer community (and in other disease areas) until insurance benefit design is modernized to keep pace with medical innovation. Patients and their physicians should be able to make choices about treatment based on what is most therapeutic and what gives each patient the best chance of survival, NOT based on insurance coverage and reimbursement. Access to oral treatments is a life or death situation for many patients and the IMF supports any efforts to remove barriers to accessing the life-saving treatments that patients need.

13 FOR MORE INFORMATION Talk to our patient advocates in the audience today Arrange for a meeting to speak to our patients and LLS Staff Contact Info: Lynne Graziano Morin Senior Patient Services Manager, Mass Chapter lynne.morin@lls.org (508)