Coverage for New Oral Cancer Drugs

June 1, 2001

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)

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

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

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