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Coverage for New Oral Cancer Drugs

Coverage for New Oral Cancer Drugs

While many people continue to worry about Medicare’s coverage of currently available oral chemotherapy drugs, Rep. Deborah Pryce (R-Ohio) is waving a warning flag about future drugs. Her Access to Cancer Therapies Act (H.R. 1624) was introduced on April 26.

"New oral drug therapies are being developed to treat cancer in less invasive, more effective ways," she said. "This good news about cancer therapies could mean bad news for seniors if the Medicare program is not updated."

Currently, Medicare covers many oral chemotherapy drugs, but only if they have to be administered intravenously in a doctor’s office or in an outpatient department. This policy encompasses 90% to 95% of cancer drug therapy. There are many new oral cancer drugs in the pipeline that will not fall under Medicare’s strict definitions for coverage. If Congress approves a Medicare outpatient drug benefit, these new drugs would probably be covered. But in the interim, as these new drugs come on the market, they will not qualify for the current, limited Medicare coverage. Oral drugs currently make up only 5% of the oncology market, but that will increase to 25% or more in the next decade, according to Pryce.

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