LETTER TO A P&T COMMITTEE
Dear (Name): Collectively, we are writing in regard to the (State Committee)’s planned review of oral oncology medicines during its scheduled (Date), meeting in (Location). We appreciate the P&T Committee not reviewing oral oncology drugs last year. As (Title) of (Organization), an organization representing physicians, nurses, and professionals all dedicated to the treatment of cancer, we are taking this opportunity to express our concern and the concerns of multiple statewide provider, patient and advocacy groups on the proposed review of oral oncology medications this year. (Organization) and the above listed organizations are frequently called upon to comment on state-based policy and legislation. Two years ago, the Committee recommended that all oral oncology drugs be designated as preferred on the Preferred Drug List (PDL) and that all would require prior authorization. We believe this is a reasonable policy to allow patients to have access to the best drugs available while ensuring effective utilization oversight. Cancer therapies are not interchangeable. They often have different indications, different mechanisms of action and different side effect profiles. The physician takes several factors related to both the medicine and the patient into account when considering treatment options: evidence of the drug’s efficacy and safety from the drug label and other published studies; patient tumor type, state of disease, biomarker status if applicable, and health status. Adding formulary status to the decision making process introduces non-clinical factors that may compromise quality patient care. The federal government has explicitly endorsed oral cancer drugs as one of only six “protected classes” in the Medicare program. Federal law requires health plans to cover “all or substantially all” oral oncology medicines. The federal government has found that this class requires special protections given the life-threatening nature of cancer, and the lack of interchangeability among treatment options. Cancer patients on Medicaid already have poorer outcomes compared to both commercially insured and the uninsured. Restricting access to necessary medication might only exacerbate these disparities. Collectively, we urge the (Committee) to not restrict access to these life-saving drugs beyond what was determined in the last review. Respectfully submitted by the following patient and provider advocate organizations on behalf of their (State) chapters and/or constituents.
Examples have been provided by advocacy and professional societies and have been de-identified. For illustrative purposes only.
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