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.