II 

116TH CONGRESS 

1ST SESSION S. 741 

To amend the Public Health Service Act to require group and individual 

health insurance coverage and group health plans to provide for cost 

sharing for oral anticancer drugs on terms no less favorable than the 

cost sharing provided for anticancer medications administered by a health 

care provider. 

IN THE SENATE OF THE UNITED STATES 

MARCH 12, 2019 

Ms. SMITH (for herself, Mr. MORAN, Mr. MURPHY, and Mr. WICKER) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to require group 

and individual health insurance coverage and group 

health plans to provide for cost sharing for oral 

anticancer drugs on terms no less favorable than the 

cost sharing provided for anticancer medications administered by a health care provider. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Cancer Drug Parity 

5 Act of 2019’’. 


kjohnson on DSK79L0C42 with BILLS
2 

•S 741 IS

1 SEC. 2. PARITY IN COST SHARING FOR ORAL ANTICANCER 

2 DRUGS. 

3 (a) REQUIREMENT.— 

4 (1) IN GENERAL.—Section 2719A of the Public 

5 Health Service Act (42 U.S.C. 300gg–19a) is 

6 amended by adding at the end the following new 

7 subsection: 

8 ‘‘(e) PARITY IN COST SHARING FOR ORAL

9 ANTICANCER DRUGS.— 

10 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 

11 group health plan, and a health insurance issuer of12 fering group or individual health insurance coverage, 

13 that provides benefits with respect to anticancer 

14 medications administered by a health care provider 

15 shall provide that any cost sharing for prescribed, 

16 patient-administered anticancer medications that are 

17 used to kill, slow, or prevent the growth of cancerous 

18 cells and that have been approved by the Food and 

19 Drug Administration is no less favorable than the 

20 cost sharing for anticancer medications that is intra21 venously administered or injected by a health care 

22 provider. 

23 ‘‘(2) LIMITATION.—Paragraph (1) shall only 

24 apply to an anticancer medication that is prescribed 

25 based on a finding by the treating physician that the 

26 medication— 


kjohnson on DSK79L0C42 with BILLS
3 

•S 741 IS

1 ‘‘(A) is medically necessary for the purpose 

2 of killing, slowing, or preventing the growth of 

3 cancerous cells; or 

4 ‘‘(B) is clinically appropriate in terms of 

5 type, frequency, extent site, and duration. 

6 ‘‘(3) RESTRICTION ON CERTAIN CHANGES.—A 

7 group health plan or health insurance issuer may 

8 not, in order to comply with the requirement of 

9 paragraph (1), make changes to benefits or replace 

10 existing benefits with new benefits under the plan or 

11 health insurance coverage designed to have the effect 

12 of— 

13 ‘‘(A) imposing an increase in out-of-pocket 

14 costs with respect to anticancer medications; 

15 ‘‘(B) reclassifying benefits with respect to 

16 anticancer medications in a way that would in17 crease such costs; or 

18 ‘‘(C) applying more restrictive limitations 

19 on prescribed orally administered anticancer 

20 medications than on intravenously administered 

21 or injected anticancer medications. 

22 ‘‘(4) CONSTRUCTION.—Nothing in this sub23 section shall be construed— 


kjohnson on DSK79L0C42 with BILLS
4 

•S 741 IS

1 ‘‘(A) to require the use of orally adminis2 tered anticancer medications as a replacement 

3 for other anticancer medications; 

4 ‘‘(B) to prohibit a group health plan or 

5 health insurance issuer from requiring prior au6 thorization or imposing other appropriate utili7 zation controls in approving coverage for any 

8 chemotherapy; or 

9 ‘‘(C) to supersede a State law that pro10 vides greater protections with respect to the 

11 coverage with respect to orally administered 

12 anticancer medications than is provided under 

13 this subsection. 

14 ‘‘(5) COST SHARING DEFINED.—In this sub15 section, the term ‘cost sharing’ includes a deductible, 

16 coinsurance, copayment, and any maximum limita17 tion on the application of such a deductible, coinsur18 ance, copayment, and similar out-of-pocket ex19 penses.’’. 

20 (2) CONFORMING AMENDMENT.—Section 

21 2724(c) of the Public Health Service Act (42 U.S.C. 

22 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

23 and inserting ‘‘sections 2719A, 2725, and 2726’’. 

24 (b) CLARIFYING AMENDMENT REGARDING APPLICA25 TION TO GRANDFATHERED PLANS.—Section 


kjohnson on DSK79L0C42 with BILLS
5 

•S 741 IS

1 1251(a)(4)(A) of the Patient Protection and Affordable 

2 Care Act (42 U.S.C. 18011(a)(4)(A)) is amended by add3 ing at the end the following new clause: 

4 ‘‘(v) Section 2719A(e) (relating to 

5 cost sharing for oral anticancer drugs).’’. 

6 (c) EFFECTIVE DATE.—The amendments made by 

7 this section shall apply with respect to group health plans 

8 for plan years beginning on or after January 1, 2020, and 

9 with respect to health insurance coverage offered, sold, 

10 issued, renewed, in effect, or operated in the individual 

11 or group market on or after such date. 

Æ 


kjohnson on DSK79L0C42 with BILLS