Grothman Opens Hearing on the Unaffordability of Oral Chemotherapy Medications

WASHINGTON-Subcommittee on Health Care and Financial Services Chairman Glenn Grothman (R-Wis.) delivered opening remarks at today's hearing titled "Unequal Treatment: Addressing the Drivers of Unaffordability for Oral Chemotherapy." In his opening statement, Subcommittee Chairman Grothman showcased how Pharmacy Benefit Managers (PBMs) and health insurers have an inordinate amount of control over the prices of oral chemotherapy medications, making these drugs unaffordable for millions of Americans. He noted that PBMs have made billions by marking up these drugs by hundreds and thousands of percent when selling them through the pharmacies they own and that, in many cases, they are delaying care through "fail first" step therapy.

Below are Subcommittee Chairman Grothman's remarks as prepared for delivery:

Welcome to today's hearing of the Subcommittee on Health Care and Financial Services.

Today, we are examining why cancer patients in this country are forced to pay far more for chemotherapy in a pill than for the very same class of treatment delivered through an IV.

Chemotherapy is one of the oldest tools we have to fight cancer. For decades, it was delivered almost entirely through IV, in a hospital or a clinic.

Medicine has changed. The Food and Drug Administration has now approved more than fifty oral anticancer medications, and it is estimated that between a quarter and a third of the cancer drugs in development today will be available only as a pill.

For many patients, that is a breakthrough. An oral drug can be taken at home. It is often less invasive, less disruptive, and just as effective as an IV infusion.

For some cancers, it is the treatment the doctor prefers. For others, it is the only option a patient has.

You would think a less invasive at-home treatment would also be easier on a patient's wallet. Unfortunately, the opposite is true.

And the reason has nothing to do with medicine. It has everything to do with how the drug is billed.

When chemotherapy is delivered through an IV, it is covered under a health plan's medical benefit. The patient usually pays a modest co-pay, and their out-of-pocket costs are capped for the year.

When that exact same chemotherapy comes via a pill, it gets thrown onto the pharmacy benefit's specialty tier.

Instead of a flat co-pay, the patient pays co-insurance, a percentage of the drug's price, and in the commercial market that bill often has no cap at all.

One in ten patients prescribed an oral cancer drug face a co-pay of $2,000 or more just to fill their very first prescription. Unsurprisingly, about one in ten patients never pick up their medication at all.

Think about what that means. A cancer patient walks into the pharmacy holding a prescription that could save their life, only to leave empty-handed because they cannot afford it.

So - who profits from an arrangement like that?

The answer, far too often, is the middlemen, the Pharmacy Benefit Managers, or PBMs.

The three largest of these companies are also owned by the nation's largest health insurers.

They decide which drugs a plan will cover. They set what the patient pays. And they collect rebates calculated as a percentage of a drug's list price.

The Federal Trade Commission has found that the largest PBMs marked up specialty drugs, including oral cancer drugs, by hundreds and even thousands of percent when they were dispensed through the pharmacies these same companies own, pocketing billions of dollars in the process.

And when they are not marking up the price, they are delaying the care, through prior authorization, through "fail first" step therapy, and by forcing patients to fill their prescriptions through those same company-owned pharmacies.

43 states have passed laws to fix this, requiring that oral and IV chemotherapy be treated the same. But those state laws cannot reach the employer plans that cover most working Americans, because federal law preempts them. Only Congress can close that gap.

That is why I reintroduced the Cancer Drug Parity Act, H.R. 4101, which is bipartisan legislation with a straightforward premise: a health plan cannot charge a patient more for an oral cancer drug than for the IV treatment it already covers.

This hearing will highlight how this problem took root, how middlemen are harming patients, and what Congress must do to improve the lives of cancer patients across our nation.

We are honored to have expert witnesses with us today to help examine this crucial issue.