Cancer Drug Coverage Parity Act of 2015

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. Short title This Act may be cited as the Cancer Drug Coverage Parity Act of 2015 2. Parity in coverage for oral anticancer drugs (a) Requirement (1) In general Section 2719A of the Public Health Service Act ( 42 U.S.C. 300gg–19a (e) Parity in coverage for oral anticancer drugs (1) In general Subject to paragraph (2), a group health plan, and a health insurance issuer offering group or individual health insurance coverage, that provides benefits with respect to anticancer medications administered by a health care provider shall provide for coverage for prescribed, patient-administered anticancer medications that are used to kill, slow, or prevent the growth of cancerous cells and that have been approved by the Food and Drug Administration that is— (A) no less favorable than the coverage for anticancer medications that is intravenously administered or injected by a health care provider; and (B) not subject to any prior authorization, step therapy, dollar or durational limit, copayment, deductible or coinsurance that does not apply to such provider-administered anticancer medications. (2) Limitation Paragraph (1) shall only apply to an anticancer medication that is prescribed based on a finding by the treating physician that the medication— (A) is medically necessary for the purpose of killing, slowing, or preventing the growth of cancerous cells; or (B) is clinically appropriate in terms of type, frequency, extent site, and duration. (3) Restriction on certain changes A group health plan or health insurance issuer may not, in order to comply with the requirement of paragraph (1), make changes to benefits or replace existing benefits with new benefits under the plan or health insurance coverage designed to have the effect of— (A) imposing an increase in out-of-pocket costs with respect to anticancer medications; (B) reclassifying benefits with respect to anticancer medications in a way that would increase such costs; or (C) applying more restrictive limitations on prescribed orally administered anticancer medications than on intravenously administered or injected anticancer medications. (4) Construction Nothing in this subsection shall be construed— (A) to require the use of orally administered anticancer medications as a replacement for other anticancer medications; (B) to prohibit a group health plan or health insurance issuer from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for any chemotherapy; or (C) to supersede a State law that provides greater protections with respect to the coverage with respect to orally administered anticancer medications than is provided under this subsection. . (2) Conforming amendment Section 2724(c) of the Public Health Service Act ( 42 U.S.C. 300gg–23(c) section 2704 sections 2719A, 2725, and 2726 (b) Clarifying amendment regarding application to grandfathered plans Section 1251(a)(4)(A) of the Patient Protection and Affordable Care Act ( 42 U.S.C. 18011(a)(4)(A) (v) Section 2719A(e). . (c) Effective date The amendments made by this section shall apply with respect to group health plans for plan years beginning on or after January 1, 2016, and with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual or group market on or after such date.

Summary: Cancer Drug Coverage Parity Act of 2015 This bill amends the Public Health Service Act to require a group or individual health plan that covers anticancer medications administered by a health care provider to provide no less favorable coverage for anticancer medications administered by a patient. A plan may apply to patient-administered anticancer medications only the cost-sharing and limitations that apply to anticancer medications administered by a health care provider. These requirements apply to medication approved by the Food and Drug Administration that is prescribed based on a finding by the treating physician that the medication is medically necessary for cancer treatment and is clinically appropriate in terms of type, frequency, extent site, and duration. To comply with these requirements, health plans may not, for anticancer medications: (1) change or replace benefits to increase out-of-pocket costs; (2) reclassify benefits to increase costs; or (3) apply more restrictive limitations to orally administered medications than to intravenously administered or injected medications.