For many patients with cancer, intravenous chemotherapy treatments can be uncomfortable and inconvenient, as they require patients to leave the comfort of their homes to visit their clinician’s office. In recent years, alternatives to infused therapeutic treatments have begun to emerge and oral treatments have become more popular. Oral treatments allow patients to take the medication from the comfort of their homes, without being inconvenienced by burdensome doctor visits. However, increased convenience has come at a steep cost to patients, as patients taking oral chemotherapy often pay more for oral medications because insurers consider oral chemotherapy a pharmacy benefit, rather than a medical benefit like IV chemotherapy, which typically requires patients to cover a percentage of the drug’s overall cost. Fortunately, states have begun to take action to require health plans to provide the same cost-sharing requirements on both oral and IV chemotherapy treatments. The below map details which states have passed laws imposing such requirements:
- Prohibits payers from charging different co-payments, deductibles, or coinsurance for
oral anticancer treatments and intravenous anticancer treatments.
https://www.azleg.gov/legtext/51leg/2r/laws/0255.pdf
- Prohibits payers from charging different co-payments, deductibles, or coinsurance for
oral anticancer treatments and intravenous anticancer treatments.
https://www.arkleg.state.ar.us/Bills/FTPDocument?path=%2FBills%2F2017R%2FPublic%2FHB1592.pdf
Colorado:
- Prohibits payers from charging different co-insurance percentages or copayment amount
for oral anticancer treatments at an amount higher than intravenous anticancer treatments
co-insurance percentages or copayments.
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
https://www.cga.ct.gov/2010/ACT/PA/2010PA-00063-R00SB-00050-PA.htm
Delaware:
- Requires health plans to provide coverage of oral anticancer treatments with the same
cost sharing as (1) anticancer medication under the prescription drug benefit; or (2)
intravenous or injected anticancer medications, whichever has lower cost sharing.
https://legis.delaware.gov/json/BillDetail/GetHtmlDocument?fileAttachmentId=42584
Florida:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
https://www.flsenate.gov/Session/Bill/2013/1159/BillText/er/PDF
Georgia:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
https://www.billtrack50.com/billdetail/479856/29490
Hawaii:
- Prohibits health plans from charging different co-insurance percentages or copayment
amount for oral anticancer treatments at an amount higher than intravenous anticancer
treatments co-insurance percentages or copayments.
- Requires deductibles, copayments, coinsurance, and out-of-pocket expenses for orally
administered cancer medications to be no more restrictive
Indiana:
- Prohibits health plans from charging less favorable co-payments, deductibles, or
coinsurance for oral anticancer treatments than intravenous anticancer treatments.
http://archive.iga.in.gov/2009/bills/ES/ES0437.2.html
Iowa:
- Prohibits health plans from discriminating in cost between orally administered anticancer
medication and intravenously administered or injected cancer medications.
https://www.legis.iowa.gov/docs/publications/iactc/83.1/CH0179.pdf
Kansas:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
https://www.kansas.gov/government/legislative/bills/2010/390.pdf
- Prohibits health plans from charging a higher copayment, deductible, or coinsurance
amount of patient-administered anticancer medications than it requires for injected or
intravenously administered anticancer medications.
https://www.billtrack50.com/billdetail/447182/29490
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
https://legis.la.gov/legis/BillInfo.aspx?s=12RS&b=HB693&sbi=y
Maine:
- Requires health plans cover oral anticancer treatments equally to intravenous anticancer
treatments.
http://www.mainelegislature.org/legis/bills/display_ps.asp?ld=627&PID=1456&snum=126
Maryland:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
https://mgaleg.maryland.gov/2012rs/chapters_noln/ch_4_sb0179t.pdf
Massachusetts:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
https://legiscan.com/MA/text/S2363/2011
Minnesota:
- Prohibits health plans from imposing higher co-payments, deductibles, or coinsurance for
oral anticancer treatments than intravenous anticancer treatments.
Mississippi:
- Prohibits health plans from imposing higher co-payments, deductibles, or coinsurance
for oral anticancer treatments than intravenous anticancer treatments.
Missouri:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
https://house.mo.gov/Bill.aspx?bill=SB668&year=2014&code=R&cal=1
Nebraska:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments
https://nebraskalegislature.gov/bills/view_bill.php?DocumentID=15549
Nevada:
Prohibits health plans from covering oral anticancer treatments less favorably than
intravenous anticancer treatments.
https://www.leg.state.nv.us/Session/77th2013/Reports/history.cfm?ID=654
New Hampshire:
- Prohibits health plans from imposing higher co-payments, deductibles, or coinsurance for
oral anticancer treatments than intravenous anticancer treatments.
http://www.gencourt.state.nh.us/legislation/2015/HB0508.html
New Jersey:
- Requires health plans to cover oral anticancer medications under the same terms and
conditions as injected cancer medications.
https://www.njleg.state.nj.us/Bills/2010/S2000/1834_I1.PDF
- New Mexico:Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments
https://www.nmlegis.gov/Sessions/11%20Regular/bills/senate/SB0385PAS.pdf
New York:
- Requires health plans apply the lower cost sharing for oral anticancer treatments to be
either (1) the cost of intravenous or injected anticancer medications or (2) the cost of the
medication under the prescription drug benefit.
https://assembly.state.ny.us/leg/?default_fld=&bn=S03988&Summary=Y&Actions=Y&Text=Y&Votes=Y#S03988
North Dakota:
- Requires plans to provide the same or lower copayment, deductible, or coinsurance for
oral anticancer treatment medications compared to injected or intravenously administered
anticancer treatment medications.
https://www.ndlegis.gov/assembly/64-2015/documents/15-0117-07000.pdf
Ohio:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
http://archives.legislature.state.oh.us/bills.cfm?ID=130_SB_99
Oklahoma:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
http://webserver1.lsb.state.ok.us/cf_pdf/2013-14%20ENR/SB/SB765%20ENR.PDF
Oregon:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
https://olis.oregonlegislature.gov/liz/2007R1/Downloads/MeasureDocument/SB8/Enrolled
Pennsylvania:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
Rhode Island:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
http://webserver.rilin.state.ri.us/BillText13/HouseText13/H5354A.pdf
South Dakota:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
anticancer treatments.
https://legiscan.com/SD/bill/SB101/2015
Texas:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
or injected anticancer treatments.
https://capitol.texas.gov/tlodocs/82R/billtext/pdf/HB00438F.pdf#navpanes=0
Utah:
- Requires health plans to ensure cost sharing for oral chemotherapy is no more restrictive
than cost sharing for intravenously administered chemotherapy.
https://le.utah.gov/~2013/bills/sbillint/sb0189.pdf
Vermont:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous
or injected anticancer treatments.
https://legislature.vermont.gov/Documents/2010/Docs/ACTS/ACT061/ACT061%20As%20Enacted.pdf
Virginia:
- Requires health plans apply the same cost-sharing criteria for both oral anticancer
treatments and intravenously or injected anticancer treatments.
http://leg1.state.va.us/cgi-bin/legp504.exe?121+ful+SB450ER+pdf
Washington:
- Requires health plans to provide coverage for oral chemotherapy treatment on a basis
that is at least comparable to chemotherapy medications administered by a healthcare
provider or facility.
West Virginia:
- Requires health plans cover oral anticancer treatments no less favorably than intravenous or injected anticancer treatments.
Wisconsin:
- Prohibits health plans from requiring a higher copay, deductible, or coinsurance amount
for oral chemotherapy than it requires for injected or intravenous chemotherapy.
https://docs.legis.wisconsin.gov/2013/proposals/reg/sen/bill/sb300
Wyoming:
- Prohibits health plans from requiring a higher copay, deductible, or coinsurance amount
for oral chemotherapy than it requires for injected or intravenous chemotherapy.
https://wyoleg.gov/2015/Enroll/SF0062.pdf
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