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“Until there is a cure…there is the IMF” Women in Government Oncology Task Force July 28, 2011 HR 2746: The Cancer Coverage Parity Act of 2011 August 2011.

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Presentation on theme: "“Until there is a cure…there is the IMF” Women in Government Oncology Task Force July 28, 2011 HR 2746: The Cancer Coverage Parity Act of 2011 August 2011."— Presentation transcript:

1 “Until there is a cure…there is the IMF” Women in Government Oncology Task Force July 28, 2011 HR 2746: The Cancer Coverage Parity Act of 2011 August 2011

2 “Until there is a cure…there is the IMF” Agenda Introduction Oral Cancer Drug Parity Background HR 2746 – Cancer Coverage Parity Act of 2011 What Can You Do to Help? How to schedule a meeting What to say / talking points Do’s & Don’ts Tips for Town Hall Meetings All-Star Advocates Conclusion Next Steps Questions & Answers

3 “Until there is a cure…there is the IMF” Advocacy Training Team Meghan Buzby Christina Vargas

4 “Until there is a cure…there is the IMF” Oral Cancer Drug Parity Background Historically, chemotherapy has been administered intravenously (IV) in a physician’s office. However, as innovation has continued to evolve, oral therapies represent an increasing number of prescribed oncolytics. – 25-35% of the medications in the oncology development pipeline are oral therapies. Intravenous (IV) cancer medications are typically covered under a health plan’s medical benefit. In this situation, patients are usually required to pay an office visit co-payment and are not required to pay a separate fee for the drug. Orally administered cancer medications are typically covered under a health plan’s pharmacy benefit, and some plans require patients to pay high out of pocket copays to fill these prescriptions (avg OOP in 2009: $2942, up 17% from 2008).

5 “Until there is a cure…there is the IMF” High out-of-pocket costs for treatment places financial hardship on many cancer patients. When confronted with this reality, some choose to forgo treatment. A new study found that 10% of patients did NOT fill their initial prescriptions for oral anti-cancer medications due to high rates of cost-sharing. There are no intravenous substitutes for many oral chemotherapy drugs. Therefore, patients are forced to pay a much higher cost for necessary treatment. Patients affected by this issue include multiple myeloma, leukemia, breast, kidney, and many more patients. Oral Cancer Drug Parity Background

6 “Until there is a cure…there is the IMF” State Legislative Landscape Several states have already enacted cancer drug parity laws including: – OR (2008) – IN, IA, VT, HI (2009) – CT, KS, CO, MN(2010) – NM, WA, TX, IL (2011) *The legislation was passed in the District of Columbia in States with bills awaiting the governors signature: – New York Bills introduced this year: WI, CA, MO GA, OK, TN, NJ, MI, OH, MA, PA, SC

7 “Until there is a cure…there is the IMF” The Patients Equal Access Coalition (PEAC) is a patient-focused coalition of organizations representing patients, industry, health care professionals and care centers collaboratively working to ensure that cancer patients have equal access (and equality of insurance coverage) to all approved anticancer regimens including, but not limited to, oral and intravenous drugs, injections, surgery, radiation, transplantations, etc. PEAC’ S P OSITION : Every cancer patient should have access to the treatments recommended by their physicians. The Patient Equal Access Coalition (PEAC) believes that patients should not suffer from cost discrimination based on the type of therapy provided or the mechanism for the delivery of that therapy.

8 “Until there is a cure…there is the IMF” HR 2746, the Cancer Coverage Parity Act of 2011 Introduced earlier this month by Representative Brian Higgins (NY-27) Any health plan that provides coverage for cancer chemotherapy treatment shall provide coverage for prescribed, orally administered anticancer medication that has been approved by the FDA. Orally administered medication shall be provided at a cost not to exceed the coinsurance percentage or the copayment amount of an intravenously, port administered or an injected cancer medication. A health plan shall not achieve compliance by imposing an increase in patient out-of-pocket costs. Health plans shall not reclassify such anticancer medications, whether orally-administered, intravenously or port administered or injected, as other than medical benefits to achieve compliance with legislation.

9 “Until there is a cure…there is the IMF” Key House Committees House of Representatives Education & The Workforce Committee Health, Education, Labor and Pensions Subcommittee (HELP) Energy and Commerce Committee Health Subcommittee Ways and Means Committee Health Subcommittee

10 “Until there is a cure…there is the IMF” What Can You Do? Ask your US Representative to co-sponsor HR 2746, the Cancer Coverage Parity Act of 2011: – Send an through the IMF Action Center – Schedule a face-to-face meeting with your Rep. in your district – Attend a Town Hall Meeting

11 “Until there is a cure…there is the IMF” Your Representative Visit Click on Issues & Legislation tab at the top Click on the Current Action Alert: Help Eliminate the Disparity in Coverage for Chemotherapy Fill in your personal story in the area provided and your personal information at the bottom Your will be automatically sent to your US Representative based upon your address information

12 “Until there is a cure…there is the IMF” Personal District Visits Locate your US Representative on the Action Center PHONE Appt Secretary/Scheduler of district office noting that you are a constituent Scheduler normally will ask for a letter to be faxed or ed with details of who, when, and why – We have a template letter for you to use! If your Representative cannot meet with you, ask to meet with his/her Health LA (legislative assistant) or Staff Director

13 “Until there is a cure…there is the IMF” Personal District Visits Arrive at least 10 minutes early to your meeting Once in the meeting, introduce yourself. Be sure to tell them where you live (often times this is an easy way to connect with your Representative). Thank them for their time and explain why you are there to meet with them – be specific! “I am here to discuss HR 2746, the Cancer Coverage Parity Act of 2011 and ask for your co-sponsorship.” Use the talking points given to you from the IMF to explain the issue better Make it personal! Ask them again to please co-sponsor HR Leave the materials provided by the IMF with the Rep. or staffer Thank them again for their time and consideration

14 “Until there is a cure…there is the IMF” Group Visits A small group of constituents can provide multiple perspectives on an issue. Assign someone as meeting facilitator who makes introductions, designates certain people to speak on particular issues, and wraps up the meeting. Assign another person as note taker to record what happens at the meeting and the legislator’s response. Be sure to say thank you and leave materials behind.

15 “Until there is a cure…there is the IMF” Talking Points for Your Meeting Today, oral oncology therapies comprise about 10% available therapies. It is estimated that 25-35% of the medications in the oncology development pipeline are oral therapies. Cancer patients should have equal access to all approved anticancer regimens regardless of how they are delivered. Patients and their physicians should make decisions about treatment based on what will give the patient the best chance of survival, NOT based on insurance coverage. Many new oral drugs do NOT have IV alternatives so there isn’t a choice for treatment. Since myeloma is a relapsing and remitting disease, patients will have to use all approved treatments (including orals) at some point during the course of treatment. It is IMPERATIVE that they have ACCESS to all of them EQUALLY. HR 2746 ensures that IF a health plan covers chemotherapy- they must cover oral chemotherapy at the same reimbursement rate as chemotherapy given via IV or injection This is not a mandate. It will only apply to health plans that already cover chemotherapy

16 “Until there is a cure…there is the IMF” Town Hall Meetings Contact the Advocacy Team to find out if there is a town hall meeting in your area Learn the established procedures Be prepared in advance with your specific question: – Will you co-sponsor HR 2746, the Cancer Coverage Parity Act? – Leave behind materials Identify yourself and how you have been impacted by cancer Be polite and professional Ask for a response to your question Use your judgment Introduce yourself to the Member before or after the meeting Report back to the Advocacy team on the results of the meeting Follow up!

17 “Until there is a cure…there is the IMF” Top Ten Do’s & Don’ts #10 Plan ahead, be prepared

18 “Until there is a cure…there is the IMF” Top Ten Do’s & Don’ts #9 Be prompt, patient, and flexible

19 “Until there is a cure…there is the IMF” Top Ten Do’s & Don’ts #8 Introduce yourself & mention that you’re a constituent of the representative’s district

20 “Until there is a cure…there is the IMF” Top Ten Do’s & Don’ts #7 Be concise and stick to the talking points – but don’t be afraid to share why this issue is important to you personally!

21 “Until there is a cure…there is the IMF” Top Ten Do’s & Don’ts #6 Relax and remember that a conversation is a two-way street…

22 “Until there is a cure…there is the IMF” Top Ten Do’s & Don’ts #5 Be respectful & thank your representative for meeting with you

23 “Until there is a cure…there is the IMF” Top Ten Do’s & Don’ts #4 It’s okay to say “I don’t know” (credibility lost is hard to regain)

24 “Until there is a cure…there is the IMF” Top Ten Do’s & Don’ts #3 Ask your representative to support the bill & share your leave- behind materials

25 “Until there is a cure…there is the IMF” Top Ten Do’s & Don’ts #2 Follow-up

26 “Until there is a cure…there is the IMF” Top Ten Do’s & Don’ts #1 ENJOY MAKING AN IMPACT!!

27 “Until there is a cure…there is the IMF” All-Star Advocates Waterbury, CT Support Group Leaders, Robin & Michael Tuohy provided oral testimony in support of SB 50, the oral parity bill in CT Contact: Robin & Michael Tuohy Central New Jersey Support Group Leader, Paula Van Riper provided oral testimony to the Assembly Health Committee where it passed unanimously Contact: Paula Van Riper David Cowan, from Eunice, New Mexico, shared his story with the House, Health & Government Affairs Committee Contact: David Cowan

28 “Until there is a cure…there is the IMF” All-Star Advocates Contact: Jerry Walton Contact: Jack Aiello Norfolk, VA / Northeast NC Support Group Leader, Jerry Walton visited with his 2 Senators and Representative in DC San Francisco / Greater Bay Support Group Leader, Jack Aiello visited with his 2 Senators and Representative in DC

29 “Until there is a cure…there is the IMF” “Those who consider themselves too smart to get involved in politics are punished by being governed by those who are dumber than they are.” – Bart Simpson Remember…

30 “Until there is a cure…there is the IMF” Next Steps District Visit Info Sheet Advocacy Toolkit Talking Points & sample letters Leave Behind Materials Follow up

31 “Until there is a cure…there is the IMF” THANK YOU!! Questions & Answers


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