Introduction

Impact of the healthcare payment system on patient access to oral anticancer drugs: an illustration from the French and United States contexts

“…As a consequence, patients need supplementary insurance which often also include, significant co-payments which may be a barrier to accessing these therapies for those with low income. In 2006, the U.S. Congress passed the Medicare Prescription Drug Improvement And Modernization Act for the beneficiaries of the Medicare program that has been adopted in 33 states in May 2014 (Figure 2) [24-26]. The Medicare Part D program was implemented in 2006 to provide Medicare beneficiaries with additional coverage for pharmaceutical care including OADs.…”

“…Four criteria determine whether OADs are reimbursed or not and are subject to prior validation by the Medicare insurance scheme on a case-by-case basis. The OADs must have been approved by the Food And Drug Administration (FDA), it must be bio-equivalent to a molecule administered intravenously, it should have the same therapeutic indications to those covered by the IV treatment and should be limited to a list of diseases that can be treated by a restrictive list of oral chemotherapy (busulfan, capecitabine, cyclophosphamide, etoposide, fludarabine, melphalan, methotrexate, temozolomide, topecan) [24]. Finally the prescription of OADs should be performed by a physician or other health care practitioner licensed to prescribe chemotherapy.…”