Costs of Cancer Pills Hard to Swallow with Existing Coverage--April 2009

Jessica A. Smith, Assistant Editor
Published Online: Thursday, April 23, 2009
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Oral medications for cancer represent a whole new world for patients, allowing them to become unfettered by intravenous (IV) lines and frequent, lengthy doctor visits. Despite a burgeoning prevalence of pills and capsules for cancer treatment, many insurance companies have been slow to get on board with the movement, failing to cover them under medical benefits.

Although oral meds account for >10% of treatments for cancer today, the drugs are set to comprise 25% of all cancer medicines in a few years, according to an April 15, 2009, New York Times report. The upward mobility of the pills and capsules has done little to change health insurance norms, which offer drug coverage for medications infused at a clinic, but not for prescriptions picked up at one's pharmacy.

Prescription drug plans provide some payment for the drugs, but often come with massive copayments, or worse, the cost of the cancer treatment pills quickly exceeds a plan's annual coverage limit. The difficulties can result in patients stopping the medications completely.

Oregon has taken the lead in dealing with the issue. State legislators passed a law that requires insurance companies to provide equal coverage for oral and IV drugs. Colorado, Hawaii, Minnesota, Montana, Oklahoma, and Washington are now looking to follow suit. The problem has yet to be examined at the federal level.

Another problem associated with the trend toward oral cancer meds is that of adherence. The patient monitoring ability afforded by IV drugs is not available with pills. Though the medications offer greater independence for patients, with that independence comes the threat of a worsened condition when dosages are not followed properly, or when side effects arise.

For other articles in this issue, see:

Hospital Pharmacies Hurting from Recession

Pharmacists Increase Revenue with MTM

Diabetes, BP Drugs Taken by More Kids


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