Oncology Stakeholders Summit, Fall 2015 - Episode 11

Oral Parity Laws and Patient Cost Sharing

The panelists discussed if they believed that the oral parity laws—where patients would pay the same amount for an oral drug as an IV-administered one—would receive a political push for implementation from the federal government.

John L. Fox, MD, MHA, explained that when the laws were first introduced there was little cost sharing on the medical benefit and higher cost sharing on the pharmacy benefit. Things have changed so that, now, over 60% of patients on the commercial side of the Priority Health plan have significant deductibles and coinsurance after that. 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.

Ted Okon said he did not personally believe that there is a chance that the federal government will get involved, and that it will be up to the states. In some cases this state-by state regulation is a good thing, but there are some instances that there will be unintended consequences as Dr Fox indicated, Okon agreed. There are patients who will end up paying more for oral drugs than if they had injectables, and part of this problem is a lack of discussion with the patients. Patient groups want to hear about the value propositions, they want more advocacy and involvement, Okon said.

Okon described the studies that Community Oncology Alliance is performing on cost drivers and said that the issues are not just restricted to the drug industry but also include community oncology and academic institutions. “…I think it’s a holistic view that we need to take here in terms of where the care is delivered, the site of care and also all of the other services. A lot of people are a part of this problem and a lot of people have to be part of the solution,” Okon finished.