II 

114TH CONGRESS 

1ST SESSION S. 1566 

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 SENATE OF THE UNITED STATES 

JUNE 11, 2015 

Mr. KIRK (for himself and Mr. FRANKEN) 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 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, 

3 SECTION 1. SHORT TITLE. 

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

5 Parity Act of 2015’’. 


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1 SEC. 2. PARITY IN COVERAGE 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 COVERAGE FOR ORAL ANTICANCER

9 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 for coverage for prescribed, patient-ad16 ministered anticancer medications that are used to 

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

18 and that have been approved by the Food and Drug 

19 Administration that is— 

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

21 for anticancer medications that are intra22 venously administered or injected by a health 

23 care provider; and 

24 ‘‘(B) not subject to any prior authoriza25 tion, step therapy, dollar or durational limit, co26 payment, deductible or coinsurance that does 


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1 not apply to such provider-administered 

2 anticancer medications. 

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

4 apply to an anticancer medication that is prescribed 

5 based on a finding by the treating physician that the 

6 medication— 

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

8 of killing, slowing, or preventing the growth of 

9 cancerous cells; or 

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

11 type, frequency, extent site, and duration. 

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

13 group health plan or health insurance issuer may 

14 not, in order to comply with the requirement of 

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

16 existing benefits with new benefits under the plan or 

17 health insurance coverage designed to have the effect 

18 of— 

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

20 costs with respect to anticancer medications; 

21 ‘‘(B) reclassifying benefits with respect to 

22 anticancer medications in a way that would in23 crease such costs; or 

24 ‘‘(C) applying more restrictive limitations 

25 on prescribed orally administered anticancer 


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1 medications than on intravenously administered 

2 or injected anticancer medications. 

3 ‘‘(4) CONSTRUCTION.—Nothing in this sub4 section shall be construed— 

5 ‘‘(A) to require the use of orally adminis6 tered anticancer medications as a replacement 

7 for other anticancer medications; 

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

9 health insurance issuer from requiring prior au10 thorization or imposing other appropriate utili11 zation controls in approving coverage for any 

12 chemotherapy; or 

13 ‘‘(C) to supersede a State law that pro14 vides greater protections with respect to the 

15 coverage with respect to orally administered 

16 anticancer medications than is provided under 

17 this subsection.’’. 

18 (2) CONFORMING AMENDMENT.—Section 

19 2724(c) of the Public Health Service Act (42 U.S.C. 

20 300gg–23(c)) is amended by striking ‘‘section 2704’’ 

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

22 (b) CLARIFYING AMENDMENT REGARDING APPLICA23 TION TO GRANDFATHERED PLANS.—Section 

24 1251(a)(4)(A) of the Patient Protection and Affordable 


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1 Care Act (42 U.S.C. 18011(a)(4)(A)) is amended by add2 ing at the end the following new clause: 

3 ‘‘(v) Section 2719A(e).’’. 

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

5 this section shall apply with respect to group health plans 

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

7 with respect to health insurance coverage offered, sold, 

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

9 or group market on or after such date. 

Æ 


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