I 

115TH CONGRESS 

1ST SESSION H. R. 1409 

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 HOUSE OF REPRESENTATIVES 

MARCH 7, 2017 

Mr. LANCE (for himself, Mr. HIGGINS of New York, Mr. HARPER, Mr. FOSTER, Mr. SESSIONS, Mr. GARAMENDI, Mr. CUMMINGS, Mr. WITTMAN, 

Mr. RYAN of Ohio, Mr. POE of Texas, Ms. CLARK of Massachusetts, Ms. 

PINGREE, Mrs. BLACKBURN, Mr. KING of New York, Mrs. COMSTOCK, 

Mr. KILDEE, Mr. DONOVAN, Mr. CARTER of Georgia, Mr. DEFAZIO, Mr. 

GUTHRIE, Mr. POCAN, Mr. LONG, Mr. SWALWELL of California, Mr. 

FLORES, Mr. SEAN PATRICK MALONEY of New York, Mr. MURPHY of 

Pennsylvania, Ms. WASSERMAN SCHULTZ, Mr. LATTA, Mr. MACARTHUR, 

and Mr. KILMER) 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 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, 


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1 SECTION 1. SHORT TITLE. 

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

3 Act of 2017’’. 

4 SEC. 2. PARITY IN COST SHARING 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 COST SHARING FOR ORAL

12 ANTICANCER 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 that any cost sharing for prescribed, 

19 patient-administered anticancer medications that are 

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

21 cells and that have been approved by the Food and 

22 Drug Administration is no less favorable than the 

23 cost sharing for anticancer medications that is intra24 venously administered or injected by a health care 

25 provider. 


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

2 apply to an anticancer medication that is prescribed 

3 based on a finding by the treating physician that the 

4 medication— 

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

6 of killing, slowing, or preventing the growth of 

7 cancerous cells; or 

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

9 type, frequency, extent site, and duration. 

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

11 group health plan or health insurance issuer may 

12 not, in order to comply with the requirement of 

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

14 existing benefits with new benefits under the plan or 

15 health insurance coverage designed to have the effect 

16 of— 

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

18 costs with respect to anticancer medications; 

19 ‘‘(B) reclassifying benefits with respect to 

20 anticancer medications in a way that would in21 crease such costs; or 

22 ‘‘(C) applying more restrictive limitations 

23 on prescribed orally administered anticancer 

24 medications than on intravenously administered 

25 or injected anticancer medications. 


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1 ‘‘(4) CONSTRUCTION.—Nothing in this sub2 section shall be construed— 

3 ‘‘(A) to require the use of orally adminis4 tered anticancer medications as a replacement 

5 for other anticancer medications; 

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

7 health insurance issuer from requiring prior au8 thorization or imposing other appropriate utili9 zation controls in approving coverage for any 

10 chemotherapy; or 

11 ‘‘(C) to supersede a State law that pro12 vides greater protections with respect to the 

13 coverage with respect to orally administered 

14 anticancer medications than is provided under 

15 this subsection. 

16 ‘‘(5) COST SHARING DEFINED.—In this sub17 section, the term ‘cost sharing’ includes a deductible, 

18 coinsurance, copayment, and any maximum limita19 tion on the application of such a deductible, coinsur20 ance, copayment, and similar out-of-pocket ex21 penses.’’. 

22 (2) CONFORMING AMENDMENT.—Section 

23 2724(c) of the Public Health Service Act (42 U.S.C. 

24 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

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


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1 (b) CLARIFYING AMENDMENT REGARDING APPLICA2 TION TO GRANDFATHERED PLANS.—Section 

3 1251(a)(4)(A) of the Patient Protection and Affordable 

4 Care Act (42 U.S.C. 18011(a)(4)(A)) is amended by add5 ing at the end the following new clause: 

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

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

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

9 this section shall apply with respect to group health plans 

10 for plan years beginning on or after January 1, 2018, and 

11 with respect to health insurance coverage offered, sold, 

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

13 or group market on or after such date. 

Æ 


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