II 

113TH CONGRESS 

1ST SESSION S. 1879 

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 SENATE OF THE UNITED STATES 

DECEMBER 19, 2013 

Mr. FRANKEN (for himself and Mr. KIRK) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

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. 

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


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•S 1879 IS

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Cancer Treatment 

3 Parity Act of 2013’’. 

4 SEC. 2. PARITY IN COVERAGE FOR ORAL ANTICANCER 

5 DRUGS. 

6 (a) EMPLOYEE RETIREMENT INCOME SECURITY ACT

7 OF 1974 AMENDMENTS.—(1) Subpart B of part 7 of sub8 title B of title I of the Employee Retirement Income Secu9 rity Act of 1974 is amended by adding at the end the fol10 lowing new section: 

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

12 DRUGS. 

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

14 group health plan, and a health insurance issuer providing 

15 health insurance coverage in connection with a group 

16 health plan, that provides benefits with respect to 

17 anticancer medications administered by a health care pro18 vider shall provide for no less favorable coverage for pre19 scribed, patient-administered anticancer medications that 

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

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

22 Administration. 

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

24 an anticancer medication that is prescribed based on a 

25 finding by the treating physician that the medication— 


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•S 1879 IS

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

2 killing, slowing, or preventing the growth of can3 cerous cells; or 

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

5 frequency, extent site, and duration. 

6 ‘‘(c) APPLICATION OF COST-SHARING AND RESTRIC7 TIONS.— 

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

9 medication under subsection (a) may be subject to 

10 annual deductibles and coinsurance or copayments 

11 so long as such deductibles, coinsurance, and copay12 ments do not exceed the deductibles, coinsurance, 

13 and copayments that are applicable to anticancer 

14 medications administered by a health care provider 

15 under the plan or coverage for the same purpose. 

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

17 health insurance issuer may not, in order to comply 

18 with the requirement of subsection (a)— 

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

20 costs with respect to anticancer medications; 

21 ‘‘(B) reclassify benefits with respect to 

22 anticancer medications; or 

23 ‘‘(C) apply more restrictive limitations on 

24 prescribed orally-administered anticancer mediVerDate Mar 15 2010 23:33 Dec 26, 2013 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1879.IS S1879

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1 cations or intravenously administered or in2 jected anticancer medications. 

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

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

5 (e)(2) of section 713 shall apply with respect to the cov6 erage required by subsection (a) in the same manner as 

7 they apply with respect to the coverage required under 

8 such section, except that January 1, 2015, shall be sub9 stituted for the date referred to in subsection (b)(3) of 

10 such section. 

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

12 be construed— 

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

14 anticancer medications as a replacement for other 

15 anticancer medications; or 

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

17 insurance issuer from requiring prior authorization 

18 or imposing other appropriate utilization controls in 

19 approving coverage for any chemotherapy.’’. 

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

21 is amended by striking ‘‘section 711’’ and inserting ‘‘sec22 tions 711 and 716’’. 

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

24 is amended by striking ‘‘section 711’’ and inserting ‘‘sec25 tions 711 and 716’’. 


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

2 is amended by inserting after the item relating to section 

3 714 the following new items: 

‘‘Sec. 715. Additional market reforms. 

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

4 (b) PUBLIC HEALTH SERVICE ACT AMENDMENTS.— 

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

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

7 300gg–28), as redesignated by section 1001(2) of the Pa8 tient Protection and Affordable Care Act (Public Law 

9 111–148), the following new section: 

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

11 DRUGS. 

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

13 group health plan, and a health insurance issuer offering 

14 group or individual health insurance coverage, that pro15 vides benefits with respect to anticancer medications ad16 ministered by a health care provider shall provide for no 

17 less favorable coverage for prescribed, patient-adminis18 tered anticancer medications that are used to kill, slow, 

19 or prevent the growth of cancerous cells and that have 

20 been approved by the Food and Drug Administration. 

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

22 an anticancer medication that is prescribed based on a 

23 finding by the treating physician that the medication— 


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

2 killing, slowing, or preventing the growth of can3 cerous cells; or 

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

5 frequency, extent site, and duration. 

6 ‘‘(c) APPLICATION OF COST-SHARING AND RESTRIC7 TIONS.— 

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

9 medication under subsection (a) may be subject to 

10 annual deductibles and coinsurance or copayments 

11 so long as such deductibles, coinsurance, and copay12 ments do not exceed the deductibles, coinsurance, 

13 and copayments that are applicable to anticancer 

14 medications administered by a health care provider 

15 under the plan or coverage for the same purpose. 

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

17 health insurance issuer may not, in order to comply 

18 with the requirement of subsection (a)— 

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

20 costs with respect to anticancer medications; 

21 ‘‘(B) reclassify benefits with respect to 

22 anticancer medications; or 

23 ‘‘(C) apply more restrictive limitations on 

24 prescribed orally-administered anticancer mediVerDate Mar 15 2010 23:33 Dec 26, 2013 Jkt 039200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1879.IS S1879

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1 cations or intravenously administered or in2 jected anticancer medications. 

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

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

5 (e)(2) of section 713 of the Employee Retirement and In6 come Security Act of 1974 shall apply with respect to the 

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

8 as they apply with respect to the coverage required under 

9 such section, except that January 1, 2015, shall be sub10 stituted for the date referred to in subsection (b)(3) of 

11 such section. 

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

13 be construed— 

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

15 anticancer medications as a replacement for other 

16 anticancer medications; or 

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

18 insurance issuer from requiring prior authorization 

19 or imposing other appropriate utilization controls in 

20 approving coverage for any chemotherapy.’’. 

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

22 23(c)), as redesignated by section 1001(4) and subsection 

23 (c)(14) of section 1563 (relating to conforming amend24 ments) of Public Law 111–148, is amended by striking 

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


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

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

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

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

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

6 to individual health insurance coverage before 2014, the 

7 provisions of such section shall be treated as also included 

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

9 Act. 

10 (c) INTERNAL REVENUE CODE AMENDMENTS.— 

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

12 100 of the Internal Revenue Code of 1986, as 

13 amended by subsection (f) of section 1563 (relating 

14 to conforming amendments) of Public Law 111–148, 

15 is amended by adding at the end the following new 

16 section: 

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

18 DRUGS. 

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

20 group health plan that provides benefits with respect to 

21 anticancer medications administered by a health care pro22 vider shall provide for no less favorable coverage for pre23 scribed, patient-administered anticancer medications that 

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


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•S 1879 IS

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

2 Administration. 

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

4 an anticancer medication that is prescribed based on a 

5 finding by the treating physician that the medication— 

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

7 killing, slowing, or preventing the growth of can8 cerous cells; or 

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

10 frequency, extent site, and duration. 

11 ‘‘(c) APPLICATION OF COST-SHARING AND RESTRIC12 TIONS.— 

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

14 medication under subsection (a) may be subject to 

15 annual deductibles and coinsurance or copayments 

16 so long as such deductibles, coinsurance, and copay17 ments do not exceed the deductibles, coinsurance, 

18 and copayments that are applicable to anticancer 

19 medications administered by a health care provider 

20 under the plan for the same purpose. 

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

22 not, in order to comply with the requirement of sub23 section (a)— 

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

25 costs with respect to anticancer medications; 


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1 ‘‘(B) reclassify benefits with respect to 

2 anticancer medications; or 

3 ‘‘(C) apply more restrictive limitations on 

4 prescribed orally-administered anticancer medi5 cations or intravenously administered or in6 jected anticancer medications. 

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

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

9 (e)(2) of section 713 of the Employee Retirement and In10 come Security Act of 1974 shall apply with respect to the 

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

12 as they apply with respect to the coverage required under 

13 such section, except that January 1, 2015, shall be sub14 stituted for the date referred to in subsection (b)(3) of 

15 such section. 

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

17 be construed— 

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

19 anticancer medications as a replacement for other 

20 anticancer medications; or 

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

22 insurance issuer from requiring prior authorization 

23 or imposing other appropriate utilization controls in 

24 approving coverage for any chemotherapy.’’. 


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1 (2) CLERICAL AMENDMENT.—The table of sec2 tions for such subchapter is amended by adding at 

3 the end the following new items: 

‘‘Sec. 9815. Additional market reforms. 

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

4 (d) EFFECTIVE DATE.—The amendments made by 

5 this section shall apply with respect to group and indi6 vidual health plans for plan years beginning on or after 

7 January 1, 2015. 

8 (e) STUDY.—Not later than 2 years after the date 

9 of the enactment of this Act— 

10 (1) the Medicare Payment Advisory Commis11 sion shall complete a study that assesses how closing 

12 the Medicare part D donut hole under the amend13 ments made by section 3301 of the Patient Protec14 tion and Affordable Care Act (Public Law 111–148), 

15 as amended by section 1101 of the Health Care and 

16 Education Reconciliation Act of 2010 (Public Law 

17 111–152), affects Medicare coverage for orally ad18 ministered anticancer medications, with a particular 

19 focus on cost and accessibility; and 

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

21 of such study. 

Æ 


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