I 

113TH CONGRESS 

1ST SESSION H. R. 1801 

To amend the Employee Retirement Income Security Act of 1974, the Public 

Health Service Act, and the Internal Revenue Code of 1986 to require 

group and individual health insurance coverage and group health plans 

to provide for coverage of oral anticancer drugs on terms no less favorable than the coverage provided for anticancer medications administered 

by a health care provider. 

IN THE HOUSE OF REPRESENTATIVES 

APRIL 26, 2013 

Mr. HIGGINS (for himself, Ms. MOORE, Ms. PINGREE of Maine, Mr. 

CICILLINE, Mrs. CAPPS, Mr. GRIJALVA, Ms. WILSON of Florida, Mr. 

HASTINGS of Florida, Mr. KING of New York, Mr. RANGEL, Mr. LARSEN

of Washington, Mr. MCGOVERN, Mr. PETERS of California, Mr. WOLF, 

Mr. MORAN, and Mr. FARR) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to 

the Committees on Ways and Means and Education and the Workforce, 

for a period to be subsequently determined by the Speaker, in each case 

for consideration of such provisions as fall within the jurisdiction of the 

committee concerned 

A BILL 

To amend the Employee Retirement Income Security Act 

of 1974, the Public Health Service Act, and the Internal 

Revenue Code of 1986 to require group and individual 

health insurance coverage and group health plans to 

provide for coverage of oral anticancer drugs on terms 

no less favorable than the coverage provided for 

anticancer medications administered by a health care 

provider. 


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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 Coverage 

5 Parity Act of 2013’’. 

6 SEC. 2. PARITY IN COVERAGE FOR ORAL ANTICANCER 

7 DRUGS. 

8 (a) EMPLOYEE RETIREMENT INCOME SECURITY ACT

9 OF 1974 AMENDMENTS.—(1) Subpart B of part 7 of sub10 title B of title I of the Employee Retirement Income Secu11 rity Act of 1974 is amended by adding at the end the fol12 lowing new section: 

13 ‘‘SEC. 716. PARITY IN COVERAGE FOR ORAL ANTICANCER 

14 DRUGS. 

15 ‘‘(a) IN GENERAL.—Subject to subsection (b), a 

16 group health plan, and a health insurance issuer providing 

17 health insurance coverage in connection with a group 

18 health plan, that provides benefits with respect to 

19 anticancer medications administered by a health care pro20 vider shall provide for no less favorable coverage for pre21 scribed, patient-administered anticancer medications that 

22 are used to kill, slow, or prevent the growth of cancerous 

23 cells and that have been approved by the Food and Drug 

24 Administration. 


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1 ‘‘(b) LIMITATION.—Subsection (a) shall only apply to 

2 an anticancer medication that is prescribed based on a 

3 finding by the treating physician that the medication— 

4 ‘‘(1) is medically necessary for the purpose of 

5 killing, slowing, or preventing the growth of can6 cerous cells; or 

7 ‘‘(2) is clinically appropriate in terms of type, 

8 frequency, extent site, and duration. 

9 ‘‘(c) APPLICATION OF COST-SHARING AND RESTRIC10 TIONS.— 

11 ‘‘(1) IN GENERAL.—The coverage of anticancer 

12 medication under subsection (a) may be subject to 

13 annual deductibles and coinsurance or copayments 

14 so long as such deductibles, coinsurance, and copay15 ments do not exceed the deductibles, coinsurance, 

16 and copayments that are applicable to anticancer 

17 medications administered by a health care provider 

18 under the plan or coverage for the same purpose. 

19 ‘‘(2) RESTRICTION.—A group health plan or 

20 health insurance issuer may not, in order to comply 

21 with the requirement of subsection (a)— 

22 ‘‘(A) impose an increase in out-of-pocket 

23 costs with respect to anticancer medications; 

24 ‘‘(B) reclassify benefits with respect to 

25 anticancer medications; or 


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1 ‘‘(C) apply more restrictive limitations on 

2 prescribed orally-administered anticancer medi3 cations or intravenously administered or in4 jected anticancer medications. 

5 ‘‘(d) APPLICATION OF NOTICE, PROHIBITIONS, 

6 ETC.—The provisions of subsections (b), (c), (d), and 

7 (e)(2) of section 713 shall apply with respect to the cov8 erage required by subsection (a) in the same manner as 

9 they apply with respect to the coverage required under 

10 such section, except that January 1, 2014, shall be sub11 stituted for the date referred to in subsection (b)(3) of 

12 such section. 

13 ‘‘(e) CONSTRUCTION.—Nothing in this section shall 

14 be construed— 

15 ‘‘(1) to require the use of orally-administered 

16 anticancer medications as a replacement for other 

17 anticancer medications; or 

18 ‘‘(2) to prohibit a group health plan or health 

19 insurance issuer from requiring prior authorization 

20 or imposing other appropriate utilization controls in 

21 approving coverage for any chemotherapy.’’. 

22 (2) Section 731(c) of such Act (29 U.S.C. 1191(c)) 

23 is amended by striking ‘‘section 711’’ and inserting ‘‘sec24 tions 711 and 716’’. 


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1 (3) Section 732(a) of such Act (29 U.S.C. 1191a(a)) 

2 is amended by striking ‘‘section 711’’ and inserting ‘‘sec3 tions 711 and 716’’. 

4 (4) The table of contents in section 1 of such Act 

5 is amended by inserting after the item relating to section 

6 714 the following new items: 

‘‘Sec. 715. Additional market reforms. 

‘‘Sec. 716. Parity in coverage for oral anticancer drugs.’’. 

7 (b) PUBLIC HEALTH SERVICE ACT AMENDMENTS.— 

8 (1) Title XXVII of the Public Health Service Act is 

9 amended by inserting after section 2728 (42 U.S.C. 

10 300gg–28), as redesignated by section 1001(2) of the Pa11 tient Protection and Affordable Care Act (Public Law 

12 111–148), the following new section: 

13 ‘‘SEC. 2729. PARITY IN COVERAGE FOR ORAL ANTICANCER 

14 DRUGS. 

15 ‘‘(a) IN GENERAL.—Subject to subsection (b), a 

16 group health plan, and a health insurance issuer offering 

17 health insurance coverage, that provides benefits with re18 spect to anticancer medications administered by a health 

19 care provider shall provide for no less favorable coverage 

20 for prescribed, patient-administered anticancer medica21 tions that are used to kill, slow, or prevent the growth 

22 of cancerous cells and that have been approved by the 

23 Food and Drug Administration. 


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1 ‘‘(b) LIMITATION.—Subsection (a) shall only apply to 

2 an anticancer medication that is prescribed based on a 

3 finding by the treating physician that the medication— 

4 ‘‘(1) is medically necessary for the purpose of 

5 killing, slowing, or preventing the growth of can6 cerous cells; or 

7 ‘‘(2) is clinically appropriate in terms of type, 

8 frequency, extent site, and duration. 

9 ‘‘(c) APPLICATION OF COST-SHARING AND RESTRIC10 TIONS.— 

11 ‘‘(1) IN GENERAL.—The coverage of anticancer 

12 medication under subsection (a) may be subject to 

13 annual deductibles and coinsurance or copayments 

14 so long as such deductibles, coinsurance, and copay15 ments do not exceed the deductibles, coinsurance, 

16 and copayments that are applicable to anticancer 

17 medications administered by a health care provider 

18 under the plan or coverage for the same purpose. 

19 ‘‘(2) RESTRICTION.—A group health plan or 

20 health insurance issuer may not, in order to comply 

21 with the requirement of subsection (a)— 

22 ‘‘(A) impose an increase in out-of-pocket 

23 costs with respect to anticancer medications; 

24 ‘‘(B) reclassify benefits with respect to 

25 anticancer medications; or 


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1 ‘‘(C) apply more restrictive limitations on 

2 prescribed orally-administered anticancer medi3 cations or intravenously administered or in4 jected anticancer medications. 

5 ‘‘(d) APPLICATION OF NOTICE, PROHIBITIONS, 

6 ETC.—The provisions of subsections (b), (c), (d), and 

7 (e)(2) of section 713 of the Employee Retirement and In8 come Security Act of 1974 shall apply with respect to the 

9 coverage required by subsection (a) in the same manner 

10 as they apply with respect to the coverage required under 

11 such section, except that January 1, 2014, shall be sub12 stituted for the date referred to in subsection (b)(3) of 

13 such section. 

14 ‘‘(e) CONSTRUCTION.—Nothing in this section shall 

15 be construed— 

16 ‘‘(1) to require the use of orally-administered 

17 anticancer medications as a replacement for other 

18 anticancer medications; or 

19 ‘‘(2) to prohibit a group health plan or health 

20 insurance issuer from requiring prior authorization 

21 or imposing other appropriate utilization controls in 

22 approving coverage for any chemotherapy.’’. 

23 (2) Section 2724(c) of such Act (42 U.S.C. 300gg– 

24 23(c)), as redesignated by section 1001(4) and subsection 

25 (c)(14) of the section 1563 (relating to conforming amendVerDate Mar 15 2010 02:18 May 02, 2013 Jkt 029200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H1801.IH H1801

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1 ments) of Public Law 111–148, is amended by striking 

2 ‘‘section 2704’’ and inserting ‘‘sections 2725 and 2729’’. 

3 (3) Section 2762(b)(2) of such Act (42 U.S.C. 

4 300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 

5 and inserting ‘‘sections 2751 and 2729’’. 

6 (4) For purposes of applying section 2729 of the 

7 Public Health Service Act, as inserted by paragraph (1), 

8 to individual health insurance coverage before 2014, the 

9 provisions of such section shall be treated as also included 

10 under part B of title XXVII of the Public Health Service 

11 Act. 

12 (c) INTERNAL REVENUE CODE AMENDMENTS.— 

13 (1) IN GENERAL.—Subchapter B of chapter 

14 100 of the Internal Revenue Code of 1986, as 

15 amended by subsection (f) of the section 1563 (relat16 ing to conforming amendments) of Public Law 111– 

17 148, is amended by adding at the end the following 

18 new section: 

19 ‘‘SEC. 9816. PARITY IN COVERAGE FOR ORAL ANTICANCER 

20 DRUGS. 

21 ‘‘(a) IN GENERAL.—Subject to subsection (b), a 

22 group health plan that provides benefits with respect to 

23 anticancer medications administered by a health care pro24 vider shall provide for no less favorable coverage for pre25 scribed, patient-administered anticancer medications that 


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1 are used to kill, slow, or prevent the growth of cancerous 

2 cells and that have been approved by the Food and Drug 

3 Administration. 

4 ‘‘(b) LIMITATION.—Subsection (a) shall only apply to 

5 an anticancer medication that is prescribed based on a 

6 finding by the treating physician that the medication— 

7 ‘‘(1) is medically necessary for the purpose of 

8 killing, slowing, or preventing the growth of can9 cerous cells; or 

10 ‘‘(2) is clinically appropriate in terms of type, 

11 frequency, extent site, and duration. 

12 ‘‘(c) APPLICATION OF COST-SHARING AND RESTRIC13 TIONS.— 

14 ‘‘(1) IN GENERAL.—The coverage of anticancer 

15 medication under subsection (a) may be subject to 

16 annual deductibles and coinsurance or copayments 

17 so long as such deductibles, coinsurance, and copay18 ments do not exceed the deductibles, coinsurance, 

19 and copayments that are applicable to anticancer 

20 medications administered by a health care provider 

21 under the plan for the same purpose. 

22 ‘‘(2) RESTRICTION.—A group health plan may 

23 not, in order to comply with the requirement of sub24 section (a)— 


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1 ‘‘(A) impose an increase in out-of-pocket 

2 costs with respect to anticancer medications; 

3 ‘‘(B) reclassify benefits with respect to 

4 anticancer medications; or 

5 ‘‘(C) apply more restrictive limitations on 

6 prescribed orally-administered anticancer medi7 cations or intravenously administered or in8 jected anticancer medications. 

9 ‘‘(d) APPLICATION OF NOTICE, PROHIBITIONS, 

10 ETC.—The provisions of subsections (b), (c), (d), and 

11 (e)(2) of section 713 of the Employee Retirement and In12 come Security Act of 1974 shall apply with respect to the 

13 coverage required by subsection (a) in the same manner 

14 as they apply with respect to the coverage required under 

15 such section, except that January 1, 2014, shall be sub16 stituted for the date referred to in subsection (b)(3) of 

17 such section. 

18 ‘‘(e) CONSTRUCTION.—Nothing in this section shall 

19 be construed— 

20 ‘‘(1) to require the use of orally-administered 

21 anticancer medications as a replacement for other 

22 anticancer medications; or 

23 ‘‘(2) to prohibit a group health plan or health 

24 insurance issuer from requiring prior authorization 


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1 or imposing other appropriate utilization controls in 

2 approving coverage for any chemotherapy.’’. 

3 (2) CLERICAL AMENDMENT.—The table of sec4 tions for such subchapter is amended by adding at 

5 the end the following new items: 

‘‘Sec. 9815. Additional market reforms. 

‘‘Sec. 9816. Parity in coverage for oral anticancer drugs.’’. 

6 (d) CLARIFYING AMENDMENT REGARDING APPLICA7 TION TO GRANDFATHERED PLANS.—Section 

8 1251(a)(4)(A) of the Patient Protection and Affordable 

9 Care Act (Public Law 111–148; 42 U.S.C. 

10 18011(a)(4)(A)), as added by section 2301(a) of Public 

11 Law 111–152, is amended by adding at the end the fol12 lowing new clause: 

13 ‘‘(v) Section 2729, as added by sec14 tion 2(b) of the Cancer Drug Coverage 

15 Parity Act of 2013.’’. 

16 (e) EFFECTIVE DATE.—The amendments made by 

17 this section shall apply with respect to group health plans 

18 for plan years beginning on or after January 1, 2014, and 

19 with respect to health insurance coverage offered, sold, 

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

21 market on or after such date. 

22 (f) STUDY.—Not later than 2 years after the date 

23 of the enactment of this Act— 


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1 (1) the Medicare Payment Advisory Commis2 sion shall complete a study that assesses how closing 

3 the Medicare part D donut hole under the amend4 ments made by section 3301 of the Patient Protec5 tion and Affordable Care Act (Public Law 111–148), 

6 as amended by section 1101 of the Health Care and 

7 Education Reconciliation Act of 2010 (Public Law 

8 111–152), affects Medicare coverage for orally ad9 ministered anticancer medications, with a particular 

10 focus on cost and accessibility; and 

11 (2) submit a report to Congress on the results 

12 of such study. 

Æ 


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