Currently Viewing:
Newsroom
Currently Reading
ADA 2018 Standards Address Drugs With CV Benefits, Hold Firm on Blood Pressure
December 10, 2017 – Mary Caffrey
UC San Diego Researchers Receive $600,000 Grant to Test PI3Ky Inhibitor
December 08, 2017 – Kelly Davio
5 Approvals and Updates From the FDA This Week
December 08, 2017 – Jaime Rosenberg
AJMC® in the Press, December 8, 2017
December 08, 2017 – AJMC Staff
What We're Reading: Drug Imports; Insurers See ACA Profits; Alzheimer's Forecast
December 08, 2017 – AJMC Staff
This Week in Managed Care: December 8, 2017
December 08, 2017
Company Says It Will Seek FDA Approval for Video Game to Treat ADHD
December 07, 2017 – Allison Inserro
After Years of Research Into Dissatisfaction With Quality Measures, Is CMS Listening?
December 07, 2017 – Allison Inserro
Ribociclib Plus Oral Endocrine Partner Shows Efficacy in Women With HR+/HER2- Breast Cancer
December 07, 2017 – Jaime Rosenberg

Do Oral Parity Laws Reduce OOP Spending for Patients?

Surabhi Dangi-Garimella, PhD
According to a new analysis by Stacy Dusetzina, PhD, and colleagues, state oral parity laws—devised to equate out-of-pocket (OOP) spending for patients, irrespective of whether their treatment is an oral agent or an infusion—are not consistent with reducing patient OOP costs for oral anticancer agents.
 
According to a new analysis by Stacy Dusetzina, PhD, and colleagues, state oral parity laws—devised to equate out-of-pocket (OOP) spending for patients, irrespective of whether their treatment is an oral agent or an infusion—are not consistent with reducing patient OOP costs for oral anticancer agents.

The medical versus pharmacy benefit equation has shifted for these oral agents. John Fox, MD, MHA, senior medical director and vice president of Medical Affairs, Priority Health, explained during a panel discussion that more than 60% of patients on the commercial side of their plans have significant deductibles and coinsurance. “There is less cost sharing on the pharmacy benefit for an oral cancer drug than on the medical benefit but an unintended consequence of this is that oral prices may increase for patients.”

For the present study, published in JAMA Oncology, researchers at the University of North Carolina, Harvard Medical School, and Brigham and Women’s Hospital analyzed claims data from 3 insurance plans for the period between 2008 and 2012, aggregated by the Health Care Cost Institute. The nearly 64,000 adults in the study lived in 1 of 16 states that passed the oral parity laws during the study period and had received anticancer treatment for which an oral option was available. Primary outcomes being evaluated were:
  • Anticancer medication use
  • Out-of-pocket spending
  • Total healthcare spending
The use of oral anticancer agents, measured as a percentage of overall anticancer treatment, rose from 18% to 22% during the study period, in the months prior to and after parity. Prescription fills for oral therapies without copayment rose from 15.0% to 53.0% among plans subject to parity, compared with a 12.3% to 18.0% increase in plans not subject to parity (P<.001).  

Additionally, patients with monthly OOP spends of over $100 increased from 8.4% to 11.1% in plans subject to parity, while those not subject to parity saw a slight decline: 12.0% to 11.7% (P = .004). Importantly, patient monthly OOP spending varied based on the actual OOP amount after parity:
  • Spending decreased by $19.44 at the 25th percentile
  • Spending decreased by $32.13 at the 50th percentile
  • Spending decreased by $10.83 at the 75th percentile
  • Spending increased by $37.19 at the 90th
  • Spending increased by $143.25 at the 95th percentile
The 6-month total spending did not change post-parity for oral or any anticancer therapy users.

Based on their results, the authors conclude that, despite the slight financial protection, “parity laws may not be sufficient to ensure that patients are protected from high out-of-pocket medication costs.”

 
Copyright AJMC 2006-2017 Clinical Care Targeted Communications Group, LLC. All Rights Reserved.
x
Welcome the the new and improved AJMC.com, the premier managed market network. Tell us about yourself so that we can serve you better.
Sign Up
×

Sign In

Not a member? Sign up now!