ASCO’s Media Issue Briefs provide succinct overviews and relevant data on major policy issues impacting patients with cancer and the physicians who care for them. These briefs are designed to be especially helpful for journalists, offering background information on key issues across health policy today. Access ASCO’s full collection of Media Issue Briefs.

Issue Overview

In recent years, scientific advances have led to increased availability of orally administered medications to treat individuals with cancer, enabling many patients to undergo treatment outside of a hospital or doctor’s office and go about their daily lives with minimal disruption. Oral cancer drugs can provide significant clinical advantages over more traditional intravenous (IV) and injected anticancer medications, and in some instances, oral cancer drugs may represent the only or best treatment option. 

However, some health insurance plans impose significantly higher cost-sharing requirements on cancer patients for oral cancer therapies than for traditional infusion cancer drugs that are delivered intravenously. For most insurance plans, cancer drugs delivered by IV are covered under the medical benefit provision, while cancer drugs taken orally are often covered under the outpatient prescription drug benefit. 

Common cost-sharing requirements (such as copayments and coinsurance) imposed on patients often present significant financial barriers to optimal treatment, even as some of these treatments may have the potential to lower the overall cost of care.

Advantages of Oral and Self-Administered Anticancer Medications

• Many of the new oral oncology drugs target specific biologic processes in cancer cells and block their growth – in contrast to conventional infusion agents, which often kill both cancer and healthy cells. 
• Oral oncology drugs are often more convenient for patients who otherwise must travel to receive outpatient treatment at a hospital or doctor’s office.
• Oral chemotherapy drugs require fewer health care resources to administer (such as staff time, supplies, and facility space), reducing the strain on inpatient and ambulatory patient care settings.

States Leading on Action While Federal Action Lags

While forty-three states and the District of Columbia have enacted laws1 to ensure that patients can access oral cancer drugs under the same general cost-sharing rules as other cancer drugs, the federal government has not yet passed legislation to standardize these same safeguards for patients who receive insurance through ERISA-regulated plans. Neither the U.S. House of Representatives nor the U.S. Senate has taken action on federal oral parity legislation. ASCO continues to advocate for oral parity legislation to alleviate the financial burdens on cancer patients. ^[1]

Key Data Points

Oral Therapies: A Growing Role in Cancer Care

• It is estimated that 25% to 35% of therapies in the development pipeline are oral regimens.^[2]
• Nearly 40% of the total costs of targeted therapies in the United States are now for oral formulations, up from 26% in 2010.^[3] 

Oral Parity Makes a Difference to Patient Adherence

• When patients’ share of health care costs increases, patients are more likely to abandon treatment. The likelihood of patient abandonment increases four-fold when the cost share is greater than $500.^[4]
• It is estimated that as many as 10% of cancer patients do not fill oral prescriptions – and, thus, do not receive their recommended cancer treatment – due to high out-of-pocket costs.^[5] 

Financial Impact on Patients 

• According to a 2010 study, oral parity laws would have a minimal impact on most health plans. Estimates show that on average the cost would be less than 50 cents per insurance plan member per month.^[5]

“In some instances, oral medications are the best or only choice of treatment for patients with cancer. Many health insurance plans, however, impose significantly higher cost-sharing requirements for oral cancer drugs than for traditional treatments, imposing a detrimental financial burden on patients who need access to these life-extending drugs for their cancer treatment. Moreover, studies document that the more patients pay out of pocket, the lower their compliance with oral medications.”  – Former ASCO President Daniel F. Hayes, MD, FACP, FASCO

For More Information

• ASCO’s letter of support for federal oral parity legislation
• ASCO in Action offers the latest news and information on this and other cancer policy topics
• To schedule a media interview with an ASCO spokesperson or oncology expert, please contact mediateam@asco.org