If is passes, new legislation will help patients with cancer get started on tablets in a timelier manner.
The Timely Access to Cancer Treatment (TACT) Act of 2021 (HR 3258), introduced by US Representatives Terri Sewell (AL) and Gus Bilirakis (FL), would require that oral cancer drugs be provided within an acceptable time frame.
Specifically, the TACT Act guarantees that patients will receive their prescribed oral cancer medications within 72 hours when middlemen, such as pharmacy benefit managers (PBMs), require that these medications are obtained from their corporate mail order pharmacies. The 72-hour time frame begins after the patient receives the prescription and includes the time for benefits verification, prior authorization, or any other administrative procedure required prior to the pharmacy being authorized to dispense the medication.
“Undergoing treatment for cancer is difficult enough. No patient should also have to worry about delays in receiving potentially life-saving medication,” said Rep. Sewell, in a statement. “The TACT Act is a simple, commonsense solution that would remove unnecessary roadblocks and empower doctors to get their patients the critical care that they need in a timely manner.”
The Community Oncology Alliance (COA) reports that PBMs are having a major impact on the lives of cancer patients and on how oncologists deliver care, owing to delays and even refusal to approve the medication unless certain criteria are met. The PBMs are also making it more difficult for in-office pharmacies to survive.
“We worked with Congress to get this bill off the ground, and whenever you have bipartisan legislation, that shows the importance of the issue,” said Ted Okon, executive director of the COA. “We have a leading Democrat and Republican come together and say that we need to pass legislation and that no cancer patient should be subservient to the whims of PBMs.
“This is a patient empowerment bill, and it’s saying that we will make sure that you get your medication within 72 hours,” Okon told Medscape Medical News.
Prior authorization is the bane of many specialties, but in oncology, the delays can mean the difference between life or death. Turnaround times for authorizations are increasing, and the process has become more complicated. It can sometimes take 2 to 3 weeks to get an oral medication to patients, Okon said.
“This bill is about removing the red tape within our healthcare system and ensuring that cancer patients have timely access to their medications,” said Rep. Bilirakis in a statement. “Doctors, not bureaucrats, best understand the needs of their patients and should be empowered with the tools needed to provide the best possible care — especially when time is of the essence.”
Specifically, the new legislation would do the following:
Require PBMs, plan sponsors, insurers, and pharmacies, including specialty and mail order pharmacies, to ensure that patients with cancer receive their medication within 72 hours of the prescription being submitted to the pharmacy benefit plan provider;
Allow patients who are not able to receive their prescription from a pharmacy benefit plan provider within 72 hours to seek pharmacy services and receive their prescription medication from any other duly-licensed entity that is able to fill it and that it will be covered by the patient’s insurance plan with full use of the patient’s applicable benefit(s);
Require pharmacy benefit plan providers to confirm within 24 hours to the prescriber that the prescription has been received and that they are able to fill it within the 72-hour period;
Require that any prior authorization required by the pharmacy benefit plan provider take place in such a time that the 72-hour time limit is not exceeded.
A First Step
“This is a positive step for patients, and in the right direction, as so many wait weeks for their medication,” says Josh Cox, PharmD, BCPS, director of pharmacy with Dayton Physicians Network, Ohio. “Delays can be devastating for patient care.”
Although he believes this new bill is very important, he is a little concerned at how it will all play out.
The logistics in getting patients their medication within the allotted time frame could prove problematic. “I work for a community college practice, and we have a pharmacy on the premises, so we have everything we need and all of the patient records,” Cox said. “Patients get their drugs right away, as we are able to facilitate the flow of information in real time.”
However, this is not possible with an outside pharmacy, Cox told Medscape Medical News. “We have immediate access to labs, records, everything, and all of that has to be gathered by the outside pharmacy. It can take time to get that information, in addition to dealing with the prior authorization and all of the other steps.”
That said, he is “cautiously optimistic” that the bill, if it passes, will have a positive impact. “But it falls short from the ideal,” he said. “We need to allow patient choice. Some patients will be fine getting them from the specialty pharmacy, but others will choose another option.”
Another pharmacist agrees and feels that to be really effective, the bill “needs some teeth.
“I don’t think the teeth are in the bill,” said Howard Levine, PharmD, director of pharmacy, Queens Medical Associates, New York. “What happens if its day 4 and the patient is still waiting and needs their medication?”
The bill says that the patient can obtain their medication at another pharmacy and the insurer must pay for it, but that may not always be the case. “What if the insurer says that it’s out of network, or they stall on it, or something to that effect?” he said. “Is there a penalty for the insurer if there is a delay?”
Levine feels that at the very least, the TACT bill acknowledges that the problem exists, and it is taking steps to address it. “But we need to make sure that it is enforced, because cancer patients can’t wait weeks for their medication,” he said.
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