Oral Anticancer Law: Unintended Consequence

August 30, 2013
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I scratched my head when I received a letter today from Blue Cross Blue Shield of Massachusetts stating the following:

As a result of a Massachusetts State Law, some prescription anticancer medications are now available to you with no out-of-pocket costs…

It goes on to say I’ll be receiving a reimbursement for any co-pays I’ve already paid.

I scratched my head when I received a letter today from Blue Cross Blue Shield of Massachusetts stating the following:

As a result of a Massachusetts State Law, some prescription anticancer medications are now available to you with no out-of-pocket costs…

It goes on to say I’ll be receiving a reimbursement for any co-pays I’ve already paid.

health reformNo one on my plan has cancer but there is someone who takes an oral medication sometimes used for cancer. While I’m happy to have a few dollars back (the copay is $15) I was a little surprised about this law, especially since it wasn’t something I heard about.

After a little digging, I realized BCBS must be referring to the oral chemotherapy parity law that went into effect this year. The idea behind the law is that patients shouldn’t have to pay more for oral cancer medications than they do for infused medications. Plans typically cover infused chemo under the medical benefit, where out-of-pocket cost sharing is lower and usually capped, but oral medications are covered under the pharmacy benefit where they can be subject to cost-sharing as a percentage of the plan’s cost. This can mean up to thousands of dollars a month in cost sharing for expensive oral drugs, with no cap according to a blog post from the Association of Community Cancer Centers.

The law doesn’t actually require copays to be zero, it just works out that way for me because my plan (a generous one, apparently) doesn’t charge anything for infusion.

In my case the parity law is a bit silly and unneeded. Although I’m not a huge fan of mandated benefits, this one probably does make sense. In some instances I would also expect there to be net cost savings to the plan, because infusions that are performed in some settings –like hospital clinics– are very expensive due to the high facilities charges, and charges for nursing time and ancillary supplies. If you’ve ever wondered why hospitals advertise cancer treatments, it’s because services like this can be highly profitable.

So I’ll pocket my few dollars and consider myself enriched for being prompted to learn about the law.

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