Pearl 1: Oral Parity Laws and Their Impact on Cost


Peter Salgo, MD: I don’t want to leave this without talking about the oral parity laws, another attempt to get at this discrepancy, right? What are they? How do they work?

Cheryl Allen, BPharm, MBA: Well, it is an attempt to make sure that there’s some equality across the offerings in the oral space versus the infused space. And that the payers have to recognize both products and both routes of administration across the benefit. So at the end of the day what this attempts to do is open up access for our patients.

Peter Salgo, MD: If I understand the law, it says you’ve got to match the cost of an oral versus an IV [intravenous] agent, based not on whether it’s oral or IV, but whether it’s effective, not effective; what disease it’s effective for. And so this should level the playing field. Is that fair as a description?

Cheryl Allen, BPharm, MBA: As far as availability, yes. As far as pricing, it’s a little more difficult to get at parity around pricing.

Peter Salgo, MD: But isn’t that the intent?

Cheryl Allen, BPharm, MBA: The intent, yes. And as we continue, with biosimilars, with generics, working toward getting the overall costs of drug therapy down, yes.

Peter Salgo, MD: Right. But these laws are out there. Are they effective? Have they made an impact in reducing what people care about, which is their out-of-pocket cost?

Noa Biran, MD: I don’t believe they do because a lot of these oral drugs, as you stated, do not have a biosimiilar, and these manufacturers have a monopoly, so to speak, over their drug.

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