By Elizabeth M. Blanchard, MD
With so much attention focused on the activities of Congress, the White House, and federal agencies, it’s easy for folks to lose track of what’s happening in their own state. However, individual state governments play a significant role in setting health policy by regulating health care providers, insurance companies, and state Medicaid programs, as well as by serving as laboratories for health policy. When one state enacts a law or regulation, it often becomes a model for other states and the federal government.
ASCO and its State Affiliates partner to advocate on a range of policies that impact patients with cancer and their oncology care team. There are a few issue areas that were a big focus during the 2017-2018 session and will likely continue to be a priority during the 2019-2020 legislative sessions:
- Opioids: Opioid legislation is a step towards curbing the opioid crisis, but it is also important that patients with cancer-related pain have adequate access to pain relief. In 2018 alone, ASCO tracked more than 125 opioids-related bills, and between 2017-2018, the Society worked with affiliates in 16 states on comment letters and testimony that provided lawmakers with the oncology perspective on relevant legislation. Opioids-related legislation is anticipated to be introduced in all 50 states over the course of the next two years.
- Oral Parity: During the last legislative session, ASCO partnered with four societies to hold Advocacy Days, submit testimony, write letters of support, and send letters to lawmakers on the importance of ensuring parity for oral anti-cancer drugs. While oral parity legislation did not pass in any state in 2017-2018, activity on this issue is expected to continue into 2019.
- Utilization Management: Step therapy requires a patient to try and fail a therapy before getting access to the drug prescribed to them. The governors of Illinois and Colorado signed into law legislation to prohibit insurers from imposing step therapy on drugs for patients with stage IV cancer. These bills, which ASCO supported, served as a model for similar legislation in Pennsylvania, which will be re-introduced this year.
- Fertility Preservation: During the 2017-2018 legislative session, five states (Connecticut, Delaware, Illinois, Maryland, and Rhode Island) passed fertility preservation legislation that aligns with ASCO’s fertility preservation guidelines, and several others considered the legislation last year. Other states are expected to introduce similar legislation during the 2019-2020 session. This is such an important issue for our cancer survivors.
- Medicaid Waivers: This past summer, ASCO released a policy statement on Medicaid waivers in the states, which allows the Society to monitor and comment on waiver proposals that impact cancer care quality and access in states including Alabama, Maine, Michigan, and Tennessee. Many patients are not able to work during cancer therapy, though in some states, their benefits are dependent on it.
- Tobacco: In 2018, Massachusetts became the sixth state to raise the legal age to buy tobacco to 21. Florida, Rhode Island, Washington, and West Virginia all considered legislation in 2017-2018 that would raise the legal age to buy tobacco in their respective states. Although these bills weren’t signed into law, all four states—along with several others—are expected to consider similar legislation in 2019-2020.
ASCO has developed resources to help its members make their voices heard in their own states. Learn more about the state legislative process, legislative activity in your state, and send messages directly to your state representatives via the ACT Network. You can also learn more about ASCO’s state advocacy activities online.
Dr. Blanchard is the chair of ASCO’s State Affiliate Council and the chief of Hematology/Oncology at Southcoast Heath, a community hospital system located in southeastern Massachusetts. She practices community oncology with a specialty in lung cancers and supportive care.