I 

112TH CONGRESS 

1ST SESSION H. R. 2746 

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 intravenously administered anticancer 

medications. 

IN THE HOUSE OF REPRESENTATIVES 

AUGUST 1, 2011 

Mr. HIGGINS introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on 

Ways and Means and Education and the Workforce, for a period to be 

subsequently determined by the Speaker, in each case for consideration 

of such provisions as fall within the jurisdiction of the committee concerned 

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 intravenously administered anticancer medications. 

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 Coverage 

3 Parity Act of 2011’’. 

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 intra17 venously administered or injected anticancer medications 

18 shall provide for no less favorable coverage for prescribed, 

19 orally administered anticancer medication that is used to 

20 kill or slow the growth of cancerous cells and that has 

21 been approved by the Food and Drug Administration. 

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

23 anticancer medication that is prescribed based on a find24 ing by the treating physician that the medication— 

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

26 killing or slowing the growth of cancerous cells in a 


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1 manner that is in accordance with nationally accept2 ed standards of medical practice; 

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

4 frequency, extent site, and duration; and 

5 ‘‘(3) is not primarily for the convenience of the 

6 patient, physician, or other health care provider. 

7 ‘‘(c) APPLICATION OF COST-SHARING AND RESTRIC8 TIONS.— 

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

10 medication under subsection (a) may be subject to 

11 annual deductibles and coinsurance or copayments 

12 so long as such deductibles, coinsurance, and copay13 ments do not exceed the deductibles, coinsurance, 

14 and copayments that are applicable to intravenously 

15 administered or injected anticancer medications 

16 under the plan or coverage for the same purpose. 

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

18 health insurance issuer may not, in order to comply 

19 with the requirement of subsection (a)— 

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

21 costs with respect to anticancer medications; or 

22 ‘‘(B) reclassify benefits with respect to 

23 anticancer medications. 

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

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


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1 (e)(2) of section 713 shall apply with respect to the cov2 erage required by subsection (a) in the same manner as 

3 they apply with respect to the coverage required under 

4 such section, except that January 1, 2012, shall be sub5 stituted for the date referred to in subsection (b)(3) of 

6 such section. 

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

8 be construed— 

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

10 anticancer medications as a replacement for other 

11 anticancer medications; or 

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

13 insurance issuer from requiring prior authorization 

14 or imposing other appropriate utilization controls in 

15 approving coverage for any chemotherapy.’’. 

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

17 is amended by striking ‘‘section 711’’ and inserting ‘‘sec18 tions 711 and 716’’. 

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

20 is amended by striking ‘‘section 711’’ and inserting ‘‘sec21 tions 711 and 716’’. 

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

23 is amended by inserting after the item relating to section 

24 714 the following new items: 

‘‘Sec. 715. Additional market reforms. 

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


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1 (b) PUBLIC HEALTH SERVICE ACT AMENDMENTS.— 

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

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

4 300gg–28), as redesignated by section 1001(2) of the Pa5 tient Protection and Affordable Care Act (Public Law 

6 111–148), the following new section: 

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

8 DRUGS. 

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

10 group health plan, and a health insurance issuer offering 

11 group or individual health insurance coverage, that pro12 vides benefits with respect to intravenously administered 

13 or injected anticancer medications shall provide for no less 

14 favorable coverage for prescribed, orally administered 

15 anticancer medication that is used to kill or slow the 

16 growth of cancerous cells and that has been approved by 

17 the Food and Drug Administration. 

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

19 anticancer medication that is prescribed based on a find20 ing by the treating physician that the medication— 

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

22 killing or slowing the growth of cancerous cells in a 

23 manner that is in accordance with nationally accept24 ed standards of medical practice; 


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

2 frequency, extent site, and duration; and 

3 ‘‘(3) is not primarily for the convenience of the 

4 patient, physician, or other health care provider. 

5 ‘‘(c) APPLICATION OF COST-SHARING AND RESTRIC6 TIONS.— 

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

8 medication under subsection (a) may be subject to 

9 annual deductibles and coinsurance or copayments 

10 so long as such deductibles, coinsurance, and copay11 ments do not exceed the deductibles, coinsurance, 

12 and copayments that are applicable to intravenously 

13 administered or injected anticancer medications 

14 under the plan or coverage for the same purpose. 

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

16 health insurance issuer may not, in order to comply 

17 with the requirement of subsection (a)— 

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

19 costs with respect to anticancer medications; or 

20 ‘‘(B) reclassify benefits with respect to 

21 anticancer medications. 

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

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

24 (e)(2) of section 713 of the Employee Retirement and In25 come Security Act of 1974 shall apply with respect to the 


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

2 as they apply with respect to the coverage required under 

3 such section, except that January 1, 2012, shall be sub4 stituted for the date referred to in subsection (b)(3) of 

5 such section. 

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

7 be construed— 

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

9 anticancer medications as a replacement for other 

10 anticancer medications; or 

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

12 insurance issuer from requiring prior authorization 

13 or imposing other appropriate utilization controls in 

14 approving coverage for any chemotherapy.’’. 

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

16 23(c)), as redesignated by section 1001(4) and subsection 

17 (c)(14) of the section 1563 (relating to conforming amend18 ments) of Public Law 111–148, is amended by striking 

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

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

21 300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 

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

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

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

25 to individual health insurance coverage before 2014, the 


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1 provisions of such section shall be treated as also included 

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

3 Act. 

4 (c) INTERNAL REVENUE CODE AMENDMENTS.— 

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

6 100 of the Internal Revenue Code of 1986, as 

7 amended by subsection (f) of the section 1563 (relat8 ing to conforming amendments) of Public Law 111– 

9 148, is amended by adding at the end the following 

10 new section: 

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

12 DRUGS. 

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

14 group health plan that provides benefits with respect to 

15 intravenously administered or injected anticancer medica16 tions shall provide for no less favorable coverage for pre17 scribed, orally administered anticancer medication that is 

18 used to kill or slow the growth of cancerous cells and that 

19 has been approved by the Food and Drug Administration. 

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

21 anticancer medication that is prescribed based on a find22 ing by the treating physician that the medication— 

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

24 killing or slowing the growth of cancerous cells in a 


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1 manner that is in accordance with nationally accept2 ed standards of medical practice; 

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

4 frequency, extent site, and duration; and 

5 ‘‘(3) is not primarily for the convenience of the 

6 patient, physician, or other health care provider. 

7 ‘‘(c) APPLICATION OF COST-SHARING AND RESTRIC8 TIONS.— 

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

10 medication under subsection (a) may be subject to 

11 annual deductibles and coinsurance or copayments 

12 so long as such deductibles, coinsurance, and copay13 ments do not exceed the deductibles, coinsurance, 

14 and copayments that are applicable to intravenously 

15 administered or injected anticancer medications 

16 under the plan for the same purpose. 

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

18 not, in order to comply with the requirement of sub19 section (a)— 

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

21 costs with respect to anticancer medications; or 

22 ‘‘(B) reclassify benefits with respect to 

23 anticancer medications. 

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

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


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1 (e)(2) of section 713 of the Employee Retirement and In2 come Security Act of 1974 shall apply with respect to the 

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

4 as they apply with respect to the coverage required under 

5 such section, except that January 1, 2012, shall be sub6 stituted for the date referred to in subsection (b)(3) of 

7 such section. 

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

9 be construed— 

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

11 anticancer medications as a replacement for other 

12 anticancer medications; or 

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

14 insurance issuer from requiring prior authorization 

15 or imposing other appropriate utilization controls in 

16 approving coverage for any chemotherapy.’’. 

17 (2) CLERICAL AMENDMENT.—The table of sec18 tions for such subchapter is amended by adding at 

19 the end the following new items: 

‘‘Sec. 9815. Additional market reforms. 

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

20 (d) CLARIFYING AMENDMENT REGARDING APPLICA21 TION TO GRANDFATHERED PLANS.—Section 

22 1251(a)(4)(A) of the Patient Protection and Affordable 

23 Care Act (Public Law 111–148; 42 U.S.C. 

24 18011(a)(4)(A)), as added by section 2301(a) of Public 


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1 Law 111–152, is amended by adding at the end the fol2 lowing new clause: 

3 ‘‘(v) Section 2729 (relating to stand4 ards relating to benefits for minor child’s 

5 congenital or developmental deformity or 

6 disorder), as added by section 2(b) of the 

7 Cancer Drug Coverage Parity Act of 

8 2011.’’. 

9 (e) 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, 2012, and 

12 with respect to health insurance coverage offered, sold, 

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

14 market on or after such date. 

15 (f) STUDY.—Not later than 2 years after the date 

16 of the enactment of this Act— 

17 (1) the Medicare Payment Advisory Commis18 sion shall complete a study that assesses how closing 

19 the Medicare part D donut hole under the amend20 ments made by section 3301 of the Patient Protec21 tion and Affordable Care Act (Public Law 111–148), 

22 as amended by section 1101 of the Health Care and 

23 Education Reconciliation Act of 2010 (Public Law 

24 111–152), affects Medicare coverage for orally adVerDate Mar 15 2010 03:30 Aug 03, 2011 Jkt 099200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2746.IH H2746

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1 ministered anticancer medications, with a particular 

2 focus on cost and accessibility; and 

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

4 of such study. 

Æ 


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