ALEXANDRIA, Va—With 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 ACCC’s 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 patients—the Maryland and Rhode Island laws cover persons of all ages while Georgia’s 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 drug’s usual method of administration. “A HCFA working group is currently studying the issue,” he said.
