FORCE advocates for families facing hereditary breast and ovarian cancer in areas such as access to care, research funding, insurance, and privacy.
The Cancer Drug Coverage Parity Act of 2015 requires any private health plan that provides coverage for cancer chemotherapy treatment to also cover oral, self-administered anticancer medication at a cost similar to that of IV, port administered, or injected anticancer medications. Patients who receive intravenously administered therapies, covered under an insurance plan's medical benefit, are responsible only for a copayment for each office visit. Conversely, oral chemotherapy is typically covered under an insurer's pharmacy benefit, resulting in substantially higher out-of-pocket costs and a significant financial burden for many patients.
Oral anticancer drugs have become the standard of care for several types of cancer in recent years. While oral treatment may be easier than taking a trip to the infusion clinic, the pills are just as strong as intravenous forms of chemotherapy. Many of these new oral therapies target specific biologic processes in cancer cells and block cancer cell growth. In addition to their specificity, which can result in reduced toxicity and side effects, oral agents are convenient—especially for patients who travel long distances to their treatment facility.
Outdated insurance coverage policies have not kept pace with medical innovation and the growing trend toward orally administered chemotherapy. FORCE believes that every cancer patient should have access to the anticancer regimen recommended by their health care team, and should not be subject to cost discrimination based on the delivery mechanism of the therapy.
FORCE is supporting state-level efforts to address this issue in addition to the national legislative initiative. Forty-two states now have oral parity laws, with Alaska and Pennsylvania passing legislation in 2016, ensuring that cancer patients have equal access to oral anticancer medications.