ALEXANDRIA, VaWith 56% of cancer patients now receiving
off-label therapies and more than 50% of physicians
reporting problems getting reimbursement for these treatments,
assuring coverage for such medications is a major focus of the
Association of Community Cancer Centers legislative efforts at
the state level, said Christian Downs, MHA, director of Provider
Economics and Public Policy for the ACCC.
Addressing the ACCCs 25th Annual Meeting, Mr. Downs said that
31 states now require health care carriers to cover the cost of drugs
that are used for treating conditions not stated on their FDA labels,
and seven more states are also working on the issue. A bill to
mandate coverage at the federal level is also under
consideration, Mr. Downs said.
Also pending in five states are bills that would require carriers to
cover the routine costs of clinical trials, he said. Three states now
require insurers to pay these costs for cancer patientsthe
Maryland and Rhode Island laws cover persons of all ages while
Georgias law covers only children.
Another significant issue is coverage for self-administered drugs.
With a few exceptions, Medicare does not cover such treatments, and
some Medicare carriers consider as self-administered all
medications that could be self-administered, he said. The
correct criterion should be the drugs usual method of
administration. A HCFA working group is currently studying the
issue, he said.