The Complex Cancer Care Coverage Environment — What is the Role of Legislation?: A Case Study from Massachusetts
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| Titel: | The Complex Cancer Care Coverage Environment — What is the Role of Legislation?: A Case Study from Massachusetts |
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| Autoren: | Anita K. Wagner, Rebecca L. Haffajee, Christine Leopold, Christine Y. Lu |
| Quelle: | Journal of Law, Medicine & Ethics. 48:538-551 |
| Verlagsinformationen: | Cambridge University Press (CUP), 2020. |
| Publikationsjahr: | 2020 |
| Schlagwörter: | Insurance, Health, Antineoplastic Agents/economics, Insurance Coverage/legislation & jurisprudence, Antineoplastic Agents, Insurance Coverage, Neoplasms/drug therapy, 3. Good health, Insurance, 03 medical and health sciences, 0302 clinical medicine, Massachusetts, Health/legislation & jurisprudence, Neoplasms, Humans |
| Beschreibung: | Over the past decades, anti-cancer treatments have evolved rapidly from cytotoxic chemotherapies to targeted therapies including oral targeted medications and injectable immunooncology and cell therapies. New anti-cancer medications come to markets at increasingly high prices, and health insurance coverage is crucial for patient access to these therapies. State laws are intended to facilitate insurance coverage of anti-cancer therapies.Using Massachusetts as a case study, we identified five current cancer coverage state laws and interviewed experts on their perceptions of the relevance of the laws and how well they meet the current needs of cancer care given rapid changes in therapies. Interviewees emphasized that cancer therapies, as compared to many other therapeutic areas, are unique because insurance legislation targets their coverage. They identified the oral chemotherapy parity law as contributing to increasing treatment costs in commercial insurance. For commercial insurers, coverage mandates combined with the realities of new cancer medications — including high prices and often limited evidence of efficacy at approval — compound a difficult situation. Respondents recommended policy approaches to address this challenging coverage environment, including the implementation of closed formularies, the use of cost-effectiveness studies to guide coverage decisions, and the application of value-based pricing concepts. Given the evolution of cancer therapeutics, it may be time to evaluate the benefits and challenges of cancer coverage mandates. |
| Publikationsart: | Article |
| Sprache: | English |
| ISSN: | 1748-720X 1073-1105 |
| DOI: | 10.1177/1073110520958879 |
| Zugangs-URL: | https://pubmed.ncbi.nlm.nih.gov/33021165 https://research-portal.uu.nl/en/publications/a82c5549-8110-4fab-bdb4-b3c0062d6423 https://doi.org/10.1177/1073110520958879 https://www.ncbi.nlm.nih.gov/pubmed/33021165 https://journals.sagepub.com/doi/10.1177/1073110520958879?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed https://www.cambridge.org/core/journals/journal-of-law-medicine-and-ethics/article/complex-cancer-care-coverage-environment-what-is-the-role-of-legislation/55E96CF1BD44FFB13D6E5F3B403D02DC https://www.rand.org/pubs/external_publications/EP68306.html https://pubmed.ncbi.nlm.nih.gov/33021165/ |
| Rights: | Cambridge Core User Agreement |
| Dokumentencode: | edsair.doi.dedup.....97264f68f36700c86b7934f20df9c364 |
| Datenbank: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstract: | Over the past decades, anti-cancer treatments have evolved rapidly from cytotoxic chemotherapies to targeted therapies including oral targeted medications and injectable immunooncology and cell therapies. New anti-cancer medications come to markets at increasingly high prices, and health insurance coverage is crucial for patient access to these therapies. State laws are intended to facilitate insurance coverage of anti-cancer therapies.Using Massachusetts as a case study, we identified five current cancer coverage state laws and interviewed experts on their perceptions of the relevance of the laws and how well they meet the current needs of cancer care given rapid changes in therapies. Interviewees emphasized that cancer therapies, as compared to many other therapeutic areas, are unique because insurance legislation targets their coverage. They identified the oral chemotherapy parity law as contributing to increasing treatment costs in commercial insurance. For commercial insurers, coverage mandates combined with the realities of new cancer medications — including high prices and often limited evidence of efficacy at approval — compound a difficult situation. Respondents recommended policy approaches to address this challenging coverage environment, including the implementation of closed formularies, the use of cost-effectiveness studies to guide coverage decisions, and the application of value-based pricing concepts. Given the evolution of cancer therapeutics, it may be time to evaluate the benefits and challenges of cancer coverage mandates. |
|---|---|
| ISSN: | 1748720X 10731105 |
| DOI: | 10.1177/1073110520958879 |