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Oral chemotherapy parity laws modestly reduce out-of-pocket costs for patients
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Oral chemotherapy parity laws inconsistently reduced out-of-pockets costs for patients, suggesting the laws alone may not be enough to protect patients from high costs, according to published findings.
Parity laws reduced monthly out-of-pocket spending on prescriptions at the lower end of spending distribution, but increased spending for prescriptions at the highest end of the spending distribution, the research showed.
“Although parity laws appear to help reduce out-of-pocket spending for some patients, they may not fully address affordability for patients needing cancer drugs. We need to consider ways to address drug pricing directly, and to improve benefit design to make sure that all patients can access prescribed drugs,” Stacie B. Dusetzina, PhD, assistant professor in the division of pharmaceutical outcomes and policy at Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, said in a press release.
Increased oral medication use combined with high annual costs led to enactment of chemotherapy parity laws in 2008 to ensure cost-sharing equality for patients who received oral or infused anticancer medications. Since 2008, 43 states and Washington, D.C. passed laws, but the association between state oral chemotherapy parity laws for oral anticancer medication use and patient and health care spending remain unknown.
Dusetzina and colleagues evaluated health claims data of 63,780 adults (57.2% women; 76.8% aged 45 to 65 years) before and after the enactment of parity laws from 2008 to 2012. Each patient lived in one of 16 states that had passed parity laws.
Researchers identified infused anticancer therapy from outpatient and physician service claims and orally administered anticancer medications from pharmacy claims.
The researchers measured out-of-pocket spending per prescription fill on oral anticancer medications and adjusted to reflect cost of a median monthly dose. The cost to fill a prescription for cancer drugs for patients with health insurance plans covered by state laws were compared with costs for patients whose plans were not covered.
In addition, 6-month total health care spending beginning with patient’s fist observed anticancer therapy was also measured.
Oral anticancer medication use increased from 18% before parity laws to 22% after parity (adjusted difference-in-differences risk ratio = 1.04; 95% CI, 0.96-1.13). The proportion of prescription fills for oral medications without copayment increased from 15% to 53%, which more than doubled the increase in plans not subject to parity (P < .001).
The proportion of patients with out-of-pocket spending of more than $100 per month increased from 8.4% to 11.1% compared with a decline from 12% to 11.7% in plans not subject to parity (P = .004).
The estimated monthly out-of-pocket spending decreased by $19.44 at the 25th percentile, by $32.13 at the 50th percentile and $10.83 at the 75th percentile for plans subject to parity. However, monthly out-of-pocket spending increased by $37.19 at the 90th percentile and $143.25 at the 95th percentile after parity (P < .001 for all).
“One of the biggest problems with parity laws as they are written is that they don’t address the prices of these medications, which can be very high,” Dusetzina said. “Parity can be reached as long as the coverage is the same for both oral and infused cancer therapies. Because we’re now seeing more people insured by plans with high deductibles or plans that require them to pay a percentage of their drug costs, parity may not reduce spending for some patients.”
Parity laws did not increase 6-month total spending for patients of any anticancer medication or oral anticancer medication alone.
Disclosures: Dusetzina serves on the National Academy of Sciences Engineering and Medicine Committee “Ensuring Patient Access to Drug Therapies.” All other authors report no relevant financial disclosures.
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