There are very few therapies available for people with brain tumors. One type of chemotherapy, temozolomide, is one of the most widely used to treat malignant brain tumors and is part of the standard of care for many patients. For many brain tumor patients, temozolomide is the only form of chemotherapy available and for most, it is prescribed in oral form (as a pill).
- Many health insurance plans cover temozolomide (brand name: Temodar) as a pharmacy benefit and not as a medical benefit as traditional IV chemotherapy is covered. The result can be high co-pays or co-insurance in the hundreds or even thousands of dollars per month.
- An increasing number of brain tumor patients are reporting that they cannot afford the out-ofpocket costs per month to access temozolomide, yet they must access this medicine as part of their oncologist-prescribed brain tumor treatment.
- For many brain tumor patients there is not an IV chemotherapy substitute. Thus health insurance costsharing can create real economic hardships and present a barrier to the affordability of a medically necessary chemotherapy regimen.
Congress should support oral chemotherapy parity legislation.
In the House, the Cancer Drug Coverage Parity Act (HR 1801) sponsored by Rep. Brian Higgins (D-NY) and a bi-partisan group of co-sponsors, requires that if a health plan covers chemotherapy, they must cover oral chemotherapy on a no less favorable (or the same) basis as chemotherapy given through hospital administered IV or injection. Because it will only apply to health plans that already cover chemotherapy, this is not a mandate. There is currently no companion legislation in the Senate.
Not only is access to oral chemotherapy critical to proper care, it can be beneficial to the patient ‘s quality of life because they can take it at home. Health insurance should facilitate brain tumor treatment, and not create a financial barrier to it.