43 states and D.C. have enacted laws stipulating patient costs for oral anticancer treatments be no more restrictive than comparable intravenous treatment - oral parity. Michigan is one of the remaining U.S. states without such legislation intended to preserve patients’ access to oral oncolytics. Though often the best therapeutic option, oral therapies are customarily covered under the insured’s pharmacy benefit, while infused chemotherapy falls under the medical benefit. This creates wide disparities in patients’ out of pocket costs (co-pay, co-insurance, etc), making many therapies unaffordable, increasing drug non-compliance, possibly resulting in worse outcomes, among other consequences. Oral parity legislation has been introduced in each Michigan legislative session since 2011 in either the Senate or House. Despite generally bipartisan support, and passage in committee (Insurance, Health Policy) in both houses, but not in the same session, the measure has failed for 11 years. Opposition has comprised the manufacturing community, chambers of commerce and insurance industry, based on the mischaracterization that this represents a “mandate”, claiming costs would increase despite strong evidence to the contrary, including that provided by the legislative body’s own fiscal analysts. The most recent iteration cleared the House committee and received bipartisan support in the Senate Committee on Health Policy and Human Services, before slowly succumbing to election year wrangling.
MSHO has engaged at many levels, conducting calls and meetings with legislators and providing official testimony. Frustrated but not deterred by failure to pass parity legislation in Michigan, MSHO’s position is unchanged, but its understanding and tactics have evolved, including formation and use of a PAC.
Oral anticancer therapy parity legislation is needed to secure equitable access for patients. Persistence, patience and positioning are critical components of advocacy for access and equity. Pending reintroduction and with changes in legislative majorities, oral anticancer parity legislation success is now attainable.