Burden on Patients: Questions on Access to Cancer Medicines in Health Exchange Plans

Patients, especially those suffering from chronic conditions, deserve access to the medicines they need to live longer, healthier lives. Today, PhRMA released a new fact sheet on access to oncology medicines in exchange plans in 2015 (2014 fact sheet is available here). The fact sheet highlights some of the potential barriers to accessing needed treatments. Learn more on AccessBetterCoverage.org, in our patient profiles and our other fact sheets.

This is the third post in our Burden on Patients Q&A series with patient advocates. To learn more, we asked Christopher Hansen, president of the American Cancer Society Cancer Action Network, to answer a few questions. 

Question:  What is the American Cancer Society Cancer Action Network (ACS CAN) and who do you represent?

Answer: ACS CAN is the nation’s leading voice in support of public policies that help people fight cancer. We represent cancer patients, survivors, and their families nationwide. As the advocacy affiliate of the American Cancer Society, ACS CAN works to encourage lawmakers, policymakers, and candidates for elective office to make cancer a top national priority. We utilize our expert capacity in federal and state lobbying, policy development, grassroots recruitment and mobilization, and media advocacy to amplify the voices of patients in support of laws and policies that save lives from cancer. Like cancer itself, ACS CAN is nonpartisan.

Q: How do medicines help patients manage and treat cancer?

A: It’s hard to overstate the positive impact of pharmaceutical therapies on the prevention and treatment of cancer. Not long ago, a cancer diagnosis amounted to a death sentence. Today, medications are helping patients survive the disease and lead long, active lives. Other medicines are helping to prevent cancer, and still others are helping smokers to quit their deadly habit. Groundbreaking science has also led to the discovery of medications that target specific molecular or genetic alterations that may cause cancer in certain patients. Personalized medicine has the potential to revolutionize the treatment and prevention of cancer, and to save countless lives as a result.

Q: The Affordable Care Act (ACA) expanded health insurance coverage to a broader population. What are you hearing about coverage in health insurance exchanges, in particular access to oncology / cancer medicines?

A: The ACA’s patient protections have enabled millions of people – many of whom have cancer or another serious disease and were previously uninsured or underinsured – to access quality, affordable health insurance. The federal and state exchanges, or marketplaces, that were created under the law have made it possible for consumers to easily compare insurance plans and select the one that is best for them and their family.

Some surveys have shown that consumers tend to be very satisfied with the coverage they purchased through the exchange offered in their state. The ability of people with cancer or at risk for cancer to access critical prevention measures, treatments, and follow-up care will undoubtedly save lives. However, we have also seen evidence that some exchange plans include narrow coverage networks that limit patient choice of doctors, specialists, and health care facilities. We are also concerned about exchange plans that place lifesaving cancer drugs in higher tiers that require patients to pay significant and sometimes unaffordable costs out of pocket.

We have expressed these concerns to HHS, state insurance commissioners, and others, and we encourage all parties to work together to ensure that coverage sold in the exchanges is more than adequate to meet the needs of people with cancer.

Q: What are the biggest concerns facing patients with cancer in health exchanges?

The biggest concerns for cancer patients with exchange coverage are that their plan won’t cover care provided by their preferred doctor or at their preferred hospital, and that they will be forced to pay more than they can afford for lifesaving medications. Part of the solution could be education and awareness – patients need to be aware that they should look at more than just premiums when evaluating health plans. They need to consider a number of other factors – such as a plan’s coverage network and its prescription drug coverage – when determining whether a particular plan is right for them. It is also important that exchanges are set up so patients can afford the therapies they need to stay alive.

Federal and state health officials must also play a role by acting to prevent plans from defining their coverage networks so narrowly that patients cannot reasonably access health care providers near where they live. Health plans should also be urged to improve transparency by making more information easily available to consumers about the medications they cover and at what cost to patients.