Understanding Oral Parity Legislation

Understanding Oral Parity Legislation

In today's episode, we explore state and federal Oral Parity Legislation. The Oral Parity legislation initiatives attempt to address the substantial out-of-pocket costs that patients are facing when their insurance covers medications under their pharmacy benefit plan as opposed to their major medical benefits. To date, a total of forty-three (43) states and the District of Columbia have enacted some form of oral parity laws, intended to create parity in patient out-of-pocket costs between the major medical and pharmacy benefits for cancer medications. However, state laws apply only to state-regulated insurance plans that do not fall under the Employee Retirement Income Security Act (ERISA) laws, and there is wide variation in the laws that states do have in place.  As a result, only a small fraction of the affected patient population is addressed by state parity laws.  Federal legislation has been proposed multiple times over the last 12 years, but has not been passed into law.