I 

114TH CONGRESS 

1ST SESSION H. R. 2739 

To amend the Public Health Service Act 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 

JUNE 11, 2015 

Mr. LANCE (for himself, Mr. HIGGINS, Mr. FITZPATRICK, Mr. SMITH of New 

Jersey, Ms. CLARK of Massachusetts, Ms. SCHAKOWSKY, Mr. YARMUTH, 

Mr. HASTINGS, Mr. ISRAEL, Mr. DENT, Mr. KING of New York, and Mr. 

SENSENBRENNER) introduced the following bill; which was referred to the 

Committee on Energy and Commerce 

A BILL 

To amend the Public Health Service Act 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, 


smartinez on DSK4TPTVN1PROD with BILLS
2 

•HR 2739 IH

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Cancer Drug Coverage 

3 Parity Act of 2015’’. 

4 SEC. 2. PARITY IN COVERAGE FOR ORAL ANTICANCER 

5 DRUGS. 

6 (a) REQUIREMENT.— 

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

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

9 amended by adding at the end the following new 

10 subsection: 

11 ‘‘(e) PARITY IN COVERAGE FOR ORAL ANTICANCER

12 DRUGS.— 

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

14 group health plan, and a health insurance issuer of15 fering group or individual health insurance coverage, 

16 that provides benefits with respect to anticancer 

17 medications administered by a health care provider 

18 shall provide for coverage for prescribed, patient-ad19 ministered anticancer medications that are used to 

20 kill, slow, or prevent the growth of cancerous cells 

21 and that have been approved by the Food and Drug 

22 Administration that is— 

23 ‘‘(A) no less favorable than the coverage 

24 for anticancer medications that is intravenously 

25 administered or injected by a health care pro26 vider; and 


smartinez on DSK4TPTVN1PROD with BILLS
3 

•HR 2739 IH

1 ‘‘(B) not subject to any prior authoriza2 tion, step therapy, dollar or durational limit, co3 payment, deductible or coinsurance that does 

4 not apply to such provider-administered 

5 anticancer medications. 

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

7 apply to an anticancer medication that is prescribed 

8 based on a finding by the treating physician that the 

9 medication— 

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

11 of killing, slowing, or preventing the growth of 

12 cancerous cells; or 

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

14 type, frequency, extent site, and duration. 

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

16 group health plan or health insurance issuer may 

17 not, in order to comply with the requirement of 

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

19 existing benefits with new benefits under the plan or 

20 health insurance coverage designed to have the effect 

21 of— 

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

23 costs with respect to anticancer medications; 


smartinez on DSK4TPTVN1PROD with BILLS
4 

•HR 2739 IH

1 ‘‘(B) reclassifying benefits with respect to 

2 anticancer medications in a way that would in3 crease such costs; or 

4 ‘‘(C) applying more restrictive limitations 

5 on prescribed orally administered anticancer 

6 medications than on intravenously administered 

7 or injected anticancer medications. 

8 ‘‘(4) CONSTRUCTION.—Nothing in this sub9 section shall be construed— 

10 ‘‘(A) to require the use of orally adminis11 tered anticancer medications as a replacement 

12 for other anticancer medications; 

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

14 health insurance issuer from requiring prior au15 thorization or imposing other appropriate utili16 zation controls in approving coverage for any 

17 chemotherapy; or 

18 ‘‘(C) to supersede a State law that pro19 vides greater protections with respect to the 

20 coverage with respect to orally administered 

21 anticancer medications than is provided under 

22 this subsection.’’. 

23 (2) CONFORMING AMENDMENT.—Section 

24 2724(c) of the Public Health Service Act (42 U.S.C. 


smartinez on DSK4TPTVN1PROD with BILLS
5 

•HR 2739 IH

1 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

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

3 (b) CLARIFYING AMENDMENT REGARDING APPLICA4 TION TO GRANDFATHERED PLANS.—Section 

5 1251(a)(4)(A) of the Patient Protection and Affordable 

6 Care Act (42 U.S.C. 18011(a)(4)(A)) is amended by add7 ing at the end the following new clause: 

8 ‘‘(v) Section 2719A(e).’’. 

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

10 this section shall apply with respect to group health plans 

11 for plan years beginning on or after January 1, 2016, and 

12 with respect to health insurance coverage offered, sold, 

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

14 or group market on or after such date. 

Æ 


smartinez on DSK4TPTVN1PROD with BILLS