{"id":32014,"date":"2025-01-06T12:41:53","date_gmt":"2025-01-06T17:41:53","guid":{"rendered":"https:\/\/avalere.com\/?p=32014"},"modified":"2025-01-17T14:34:16","modified_gmt":"2025-01-17T19:34:16","slug":"new-resource-state-statute-oncology-drug-coverage-report","status":"publish","type":"post","link":"https:\/\/advisory.avalerehealth.com\/insights\/new-resource-state-statute-oncology-drug-coverage-report","title":{"rendered":"Updated Resource: State Statute Oncology Drug Coverage Report"},"content":{"rendered":"<p>Understanding the impact of state statutes on payer coverage for cancer treatments is important as treatment landscapes continue to evolve. Statutes are enacted state laws that may authorize administrative regulations. As of November 2024, 41 states have statutes related to coverage of oncology treatments. These statutes have a direct effect on a variety of stakeholders, including patients, providers, and payers. Policymakers in most states have enacted statues that require coverage of off-label uses of drugs\/biologics when specific criteria are met.<\/p>\n<p>One critical aspect of the statutes discussed in the report is the use of <a href=\"https:\/\/advisory.avalerehealth.com\/interviews\/clinical-pathways-in-oncology\">clinical compendia<\/a> as the basis for determining the medical appropriateness of off-label cancer treatments. As there is no federal law regarding coverage of off-label uses of medications in the commercial payer space, commercial payers\u2019 coverage criteria (e.g., prior authorization) varies across the states where payers operate. Payer policies may align with state statute, expand beyond statute, or be more restrictive. It may be complicated to keep track of where state statute would conflict with, and perhaps, override a payer coverage policy. Statutes may refer to compendia using reference or authoritative language, or by name (e.g., American Hospital Formulary Service Drug Information, National Comprehensive Cancer Network [NCCN]: NCCN Drugs &amp; Biologics Compendium [NCCN Compendium\u00ae]).<\/p>\n<p><strong>What is<\/strong><strong>\u00a0in The Report<\/strong><strong>?<\/strong><\/p>\n<p>Avalere\u2019s report provides an overview of state statutes on commercial payer coverage of drugs\/biologics that have been (1) approved by the Food and Drug Administration and (2) recognized for additional off-label use in clinical compendia for the treatment of cancer. State statute websites current as of November 2024 were used to review and analyze statutes in all 50 states, the District of Columbia, and Puerto Rico that apply to the process of how compendia are considered for determining coverage. It highlights how these statutes can vary, detailing which compendia are mentioned and any cancer-specific language.<\/p>\n<p>The State Statute Drug Coverage Report answers key questions, including:<\/p>\n<ul>\n<li>Which states have statutes related to the use of compendia to determine coverage?<\/li>\n<li>Which states have cancer-specific statutes?<\/li>\n<li>Which compendia are recognized by each state in determining coverage and reimbursement?<\/li>\n<\/ul>\n<p>The report provides an overview of state statutes in which coverage requirements are mentioned, and identifies if language confirms application to cancer, which compendia are used, how compendia are used, and if NCCN is referenced. This report serves as a supplement to other payer coverage tracking of drugs\/biologics, as the statutes in this report may override individual drug\/biologic policy coverage criteria. The goal of this report is to support coverage and reimbursement for drug\/biologic therapies when used for the treatment of cancer; it may be of interest to life science companies who are supporting providers in patient cases of appeal for declined coverage.<\/p>\n<p>This report is not an interpretation of individual treatment decisions, nor is it a recommendation for off-label usage or a guarantee of payer coverage. Notably, these are state-regulated statutes only and do not apply to self-funded, ERISA-exempt plans. It does not constitute legal advice nor opinion; rather, it is for general informational purposes only. This report can serve as an educational tool, providing insights into off-label oncology treatment policies from state perspectives. It is intended to help stakeholders navigate the complexities of using compendia to support coverage and reimbursement of cancer treatments.<\/p>\n<h2>Access The Report<\/h2>\n<p>To purchase the report or speak with an Avalere expert, <a href=\"https:\/\/pages.avalere.com\/Keep-In-Touch.html\">contact us here<\/a>.<\/p>\n<p>Avalere\u2019s experts in commercialization, regulatory, and policy strategy can help manufacturers, patient advocacy organizations, and other stakeholders analyze the statutes and access implications to off-label treatments and help develop strategies to mitigate delays in patient access to oncology treatments.\u00a0 This report offers comprehensive analysis along with recently updated state legislature.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Understanding the impact of state statutes on payer coverage for cancer treatments is important as treatment landscapes continue to evolve. Statutes are enacted state laws that may authorize administrative regulations. As of November 2024, 41 states have statutes related to coverage of oncology treatments. These statutes have a direct effect on a variety of stakeholders,&hellip;<\/p>\n","protected":false},"author":28,"featured_media":25644,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[3],"tags":[1035],"content-categories":[129],"class_list":["post-32014","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-insights","tag-trending","content-categories-drug-pricing","entry","has-media"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v24.0 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Updated Resource: State Statute Oncology Drug Coverage Report | Avalere Health Advisory<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/advisory.avalerehealth.com\/insights\/new-resource-state-statute-oncology-drug-coverage-report\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Updated Resource: State Statute Oncology Drug Coverage Report | Avalere Health Advisory\" \/>\n<meta property=\"og:description\" content=\"Understanding the impact of state statutes on payer coverage for cancer treatments is important as treatment landscapes continue to evolve. Statutes are enacted state laws that may authorize administrative regulations. As of November 2024, 41 states have statutes related to coverage of oncology treatments. These statutes have a direct effect on a variety of stakeholders,&hellip;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/advisory.avalerehealth.com\/insights\/new-resource-state-statute-oncology-drug-coverage-report\" \/>\n<meta property=\"og:site_name\" content=\"Avalere Health Advisory\" \/>\n<meta property=\"article:published_time\" content=\"2025-01-06T17:41:53+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-01-17T19:34:16+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/advisory.avalerehealth.com\/wp-content\/uploads\/2022\/04\/21108-1-Shivani-Patel_600x400.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"600\" \/>\n\t<meta property=\"og:image:height\" content=\"400\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Leah Keller\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@avalerehealth\" \/>\n<meta name=\"twitter:site\" content=\"@avalerehealth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Leah Keller\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Updated Resource: State Statute Oncology Drug Coverage Report | Avalere Health Advisory","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/advisory.avalerehealth.com\/insights\/new-resource-state-statute-oncology-drug-coverage-report","og_locale":"en_US","og_type":"article","og_title":"Updated Resource: State Statute Oncology Drug Coverage Report | Avalere Health Advisory","og_description":"Understanding the impact of state statutes on payer coverage for cancer treatments is important as treatment landscapes continue to evolve. 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Prior to joining Avalere, Leah conducted policy research and analysis on federal healthcare issues such as Medicaid coverage and payment, commercial insurance coverage and access, healthcare reform, and ACA implementation at the Guttmacher Institute, a thinktank focused on advancing reproductive health and rights. Prior, Leah coordinated data collection, analysis, and publications for George Washington University\u2019s Center for Social Well-Being and Development. Leah holds an MPH in maternal and child health from George Washington University and a BA in anthropology from St. Mary\u2019s College of Maryland.","url":"https:\/\/advisory.avalerehealth.com\/author\/lkelleravalere-com"}]}},"_links":{"self":[{"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/posts\/32014","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/users\/28"}],"replies":[{"embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/comments?post=32014"}],"version-history":[{"count":10,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/posts\/32014\/revisions"}],"predecessor-version":[{"id":33753,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/posts\/32014\/revisions\/33753"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/media\/25644"}],"wp:attachment":[{"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/media?parent=32014"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/categories?post=32014"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/tags?post=32014"},{"taxonomy":"content-categories","embeddable":true,"href":"https:\/\/advisory.avalerehealth.com\/wp-json\/wp\/v2\/content-categories?post=32014"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}