I 

118TH CONGRESS 

1ST SESSION H. R. 6301 

To amend the Employee Retirement Income Security Act of 1974 to require 

a group health plan (or health insurance coverage offered in connection 

with such a plan) 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 

NOVEMBER 8, 2023 

Mr. GROTHMAN (for himself, Ms. BONAMICI, Mr. BILIRAKIS, Mr. HIGGINS of 

New York, Mr. FITZPATRICK, Mr. MORELLE, and Ms. MATSUI) introduced the following bill; which was referred to the Committee on Education and the Workforce 

A BILL 

To amend the Employee Retirement Income Security Act 

of 1974 to require a group health plan (or health insurance coverage offered in connection with such a plan) 

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 2023’’. 

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

5 DRUGS. 

6 (a) IN GENERAL.—The Employee Retirement Income 

7 Security Act of 1974 is amended by inserting after section 

8 725 of such Act (29 U.S.C. 1185d) the following new sec9 tion: 

10 ‘‘SEC. 726. PARITY IN COST-SHARING FOR ORAL 

11 ANTICANCER DRUGS. 

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

13 group health plan (or health insurance coverage offered 

14 in connection with such a plan) that provides benefits with 

15 respect to anticancer medications administered by a health 

16 care provider shall provide that any cost-sharing for pre17 scribed, patient-administered anticancer medications that 

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

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

20 Administration is no less favorable than the cost-sharing 

21 for anticancer medications that is intravenously adminis22 tered or injected by a health care provider. 

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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•HR 6301 IH

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) RESTRICTION ON CERTAIN CHANGES.—A group 

7 health plan (or health insurance coverage offered in con8 nection with such a plan) may not, in order to comply with 

9 the requirement of subsection (a), make changes to bene10 fits or replace existing benefits with new benefits under 

11 the plan (or health insurance coverage) designed to have 

12 the effect of— 

13 ‘‘(1) imposing an increase in out-of-pocket costs 

14 with respect to anticancer medications; 

15 ‘‘(2) reclassifying benefits with respect to 

16 anticancer medications in a way that would increase 

17 such costs; or 

18 ‘‘(3) applying more restrictive limitations on 

19 prescribed orally administered anticancer medica20 tions than on intravenously administered or injected 

21 anticancer medications. 

22 ‘‘(d) CONSTRUCTION.—Nothing in this section shall 

23 be construed— 


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•HR 6301 IH

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

2 anticancer medications as a replacement for other 

3 anticancer medications; 

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

5 insurance coverage offered in connection with such a 

6 plan) from requiring prior authorization or imposing 

7 other appropriate utilization controls in approving 

8 coverage for any chemotherapy; or 

9 ‘‘(3) to supersede a State law that provides 

10 greater protections with respect to the coverage with 

11 respect to orally administered anticancer medications 

12 than is provided under this section. 

13 ‘‘(e) COST-SHARING DEFINED.—In this section, the 

14 term ‘cost-sharing’ includes a deductible, coinsurance, co15 payment, and any maximum limitation on the application 

16 of such a deductible, coinsurance, copayment, and similar 

17 out-of-pocket expenses.’’. 

18 (b) TECHNICAL CORRECTION; CLERICAL CHANGE.— 

19 The table of contents in section 1 of the Employee Retire20 ment Income Security Act of 1974 (29 U.S.C. 1001 et 

21 seq.) is amended by inserting after the item relating to 

22 section 725 the following new item: 

‘‘Sec. 726. Parity in cost-sharing for oral anticancer drugs.’’. 

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

24 this section shall apply with respect to plan years begin25 ning on or after January 1, 2024. 


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1 SEC. 3. GAO STUDY. 

2 Not later than 2 years after the date of enactment 

3 of this Act, the Comptroller General of the United States 

4 shall— 

5 (1) complete a study that assesses the impact 

6 of section 726 of the Employee Retirement Income 

7 Security Act of 1974, as added by section 2(a), on 

8 the out-of-pocket costs associated with oral and pa9 tient-administered anticancer medications furnished 

10 or dispensed to individuals enrolled in a group 

11 health plan to which such section 726 applies, in 

12 comparison to individuals enrolled in group health 

13 plans or health insurance coverage to which section 

14 726 does not apply, including any recommendations 

15 or matters for congressional consideration regarding 

16 actions Federal agencies or Congress can take to re17 duce financial barriers to access to oral and patient18 administered anticancer medications; and 

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

20 of such study, including recommendations or matters 

21 for congressional consideration to improve access to 

22 oral and patient-administered anticancer medications 

23 for individuals enrolled in group health plans and 

24 group or individual health insurance coverage of25 fered by a health insurance issuer. 

Æ 


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