Do Oral Parity Laws Reduce OOP Spending for Patients?

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.”