The U.S. Food and Drug Administration (FDA) has approved several dozens of oral medications for the treatment of oral cancer.
On top of that, a significant number of therapies and treatments are currently being developed that will be administered in oral forms. The availability of these drugs, however, doesn’t actually translate into use by patients due to soaring prices.
Implication of Rising Medication Cost
In the United States, oral cancer is estimated to account for about 2.9 percent of all cancer cases. About 2 in every 5 persons that have it and they do not live even five years after diagnosis. It has two primary types, namely: oral cavity cancer and oropharynx cancer.
While oral medications for these cancers are available on the market. It has been observed that vast many patients are not taking them. Rising drug costs is one of the main factors causing this phenomenon. Higher prices mean high out-of-pocket sums for patients and their families. This puts significant pressure on patients (and their families). Sadly, this causes many to opt-out of treatment.
Researchers found in a 2019 study published in the Journal of Clinical Oncology that the cost of drugs per patient increased significantly. This happened for the majority of medications prescribed for oral cancers between 2013 and 2015. Medicare costs for the drugs almost doubled during the period. More than 15 of these cost one patient over $50,000 in 2015, compared to two years earlier.
Scientists from the University of Pennsylvania’s Perelman School of Medicine also found that a high out-of-pocket cost might be causing some patients to go without treatment. They observed that patients failed to get prescription medications for oral cancer as prices increased. Half of all patients didn’t pick their prescriptions when required to put out-of-pocket amounts exceeded that $2,000. By comparison, only 10 percent failed to do so when out-of-pocket costs were lower than $10.
Drug Parity Laws
Some states in the U.S., including Washington, DC, have enacted what is known as parity laws to check for high out-of-pocket costs for oral cancer drugs. The principal objective of these laws is to ensure that patients who use oral drugs for cancer treatment don’t pay amounts higher than what is required for intravenous treatment.
This legislation, pioneered by Oregon, became necessary as a result of observed disparity in how patients who use oral chemo drugs and those who use infused drugs are charged. People who use oral drugs pay more because they are charged separately for a visit to an oncologist and for prescription drugs from pharmacies. However, those in the latter group only pay for the visit to an oncologist’s office, where intravenous chemotherapy is usually given.
Drug parity laws were necessary to ensure that patients do not pay more out-of-pocket for oral drugs as a result of differences in medical and pharmacy benefit coverage.
Effects of Legislation
In research funded by the American Cancer Society (ACS), Stacie B. Dusetzina and her colleagues found that drug parity laws helped to lower the costs of orally administered drugs for oral cancer. They also found that the legislation also caused some patients to pay more.
The researchers evaluated the data of health claims made by almost 63,800 adults from three national insurers in America. They utilized data from 2008 to 2012. This was done because the time-frame marks before and following the introduction of parity laws. When they compared out-of-pocket costs before and after the laws were enacted, the scientists found that the median price per fill of oral anti-cancer medications dropped to zero, from roughly $30.
However, they also found that those who were already paying the most before the laws now had to pay more after they were introduced. Patients who were paying higher, compared to more than 95 percent of others, saw their out-of-pocket costs rise by about $143 a month. The researchers said this increase might be attributable to rising deductibles.
Dusetzina noted that the Affordable Care Act (ACA) is also helpful for regulating out-of-pocket costs. The legislation requires plans to include a maximum that takes prescription drugs into consideration.
This legislation has the potential to help oral cancer patients save thousands of dollars in out-of-pocket costs for orally administered medications.
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