State Advocacy 2019 Recap: State Oncology Societies, ASCO Active on Wide Range of Issues Facing Cancer Care Delivery System

July 29, 2019

In state legislatures across the United States this year, ASCO and state societies partnered to advocate for health policies to improve the cancer care delivery system and ensure patients and survivors have access to high-quality care. Tracking more than 630 relevant state bills in the 2019 state legislative session, ASCO worked with 31 state societies to advocate on 138 different bills and other policy developments that address issues including:

  • Fertility coverage: Several states, including Texas, California, New York, New Jersey, Massachusetts, and Oregon, considered legislation that would require health benefit plans to provide coverage for fertility preservation services to patients who will receive a medically necessary treatment such as chemotherapy or radiation. New York enacted a law, and the New Hampshire legislature passed a bill that will be sent to the Governor for his signature. It will become the seventh state with such a law. ASCO submitted comment letters in support of the bills jointly with state societies and submitted written testimony in some cases.
  • Medicaid: Numerous states across the country have requested Medicaid waivers to implement programmatic changes that would make it harder for enrollees to qualify for Medicaid coverage. These waivers have included the authority to enforce non-coverage penalties, or “lock-outs,” eligibility redeterminations, and work requirements. ASCO is deeply concerned these changes could result in reduced access to care for this vulnerable population and is working with the Indiana state society and other affiliates to ensure patients with cancer have access to insurance and high-quality cancer care.
  • Oral parity: The Michigan, North Carolina, and Idaho state societies have been working, with support from ASCO, to advance legislation requiring that cost-sharing for oral and other self-administered anticancer drugs is no less favorable than for traditional intravenous (IV) medication administered in an office setting. The North Carolina bill passed the House this year.
  • Pharmacy Benefit Managers (PBMs): The Georgia Society of Clinical Oncology successfully advocated for patient protections against predatory PBM practices. Other states, including New Jersey, Ohio, North Carolina, and Pennsylvania, are considering similar legislation.
  • Tobacco: Eighteen states and the District of Columbia have already ratified statewide “Tobacco 21” legislation (T21), which prohibits the sale of tobacco products to persons under the age of 21. An additional 14 states have city and county ordinances consistent with T21. Other states, as well as the U.S. Congress, are considering legislation to raise the legal age to purchase tobacco. ASCO has submitted letters of support for T21 bills jointly with state societies, as well as written testimony in support.
  • Utilization Management: Utilization management strategies, including step therapy and prior authorization, can adversely affect physicians’ ability to provide high-quality care by prohibiting them from providing the correct course of treatment at the right time. The New Jersey and Pennsylvania legislatures are currently considering bills to provide exemptions from step therapy and prior authorization for patients with life-threatening illnesses that meet certain criteria.
    • Pathways: ASCO coordinated with the Puerto Rico Association of Hematology & Medical Oncology to weigh in on a measure that tasks a cancer-specific Advisory Board within the Puerto Rico Department of Health with developing clinical oncology pathways. These oncology-specific pathways would provide affordable access to treatment for the island’s cancer population. The bill remains pending in the House Health Committee.
    • Prior Authorization: ASCO coordinated with State Affiliates in Oregon to support state provisions improving prior authorization. Additionally, ASCO has joined a coalition letter on the Pennsylvania prior authorization bill. ASCO is currently monitoring two prior authorization bills in New Jersey.
    • Step Therapy: Over the course of the 2019 session, ASCO tracked 12 step therapy bills in coordination with State Affiliates where possible in the following states: AR, CT, HI, LA, MN, ND, OR, PA, TX, and WA. The Arkansas and North Dakota bills were later signed into law. ASCO currently belongs to a coalition in Pennsylvania supporting the step therapy bill has sent support letters for this bill jointly with the Pennsylvania affiliate society.

While most states have wrapped up their legislative sessions for the year, some states legislatures meet year-round and are still considering policies that impact cancer care. ASCO members can use the State ACT Network to learn more about cancer policy issues under consideration in their states and to advocate on issues that could affect cancer care and the practice of oncology.

Follow ASCO in Action for the news and updates on federal and state policy issues.