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 favor-
able 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 Com-
mittee 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 con-
cerned 
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 intra-
venously administered anticancer medications. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Cancer Drug Coverage 
Parity Act of 2011’’. 
SEC. 2. PARITY IN COVERAGE FOR ORAL ANTICANCER 
DRUGS. 
(a) EMPLOYEE RETIREMENT INCOME SECURITY ACT 
OF 1974 AMENDMENTS.—(1) Subpart B of part 7 of sub-
title B of title I of the Employee Retirement Income Secu-
rity Act of 1974 is amended by adding at the end the fol-
lowing new section: 
‘‘SEC. 716. PARITY IN COVERAGE FOR ORAL ANTICANCER 
DRUGS. 
‘‘(a) IN GENERAL.—Subject to subsection (b), a 
group health plan, and a health insurance issuer providing 
health insurance coverage in connection with a group 
health plan, that provides benefits with respect to intra-
venously administered or injected anticancer medications 
shall provide for no less favorable coverage for prescribed, 
orally administered anticancer medication that is used to 
kill or slow the growth of cancerous cells and that has 
been approved by the Food and Drug Administration. 
‘‘(b) LIMITATION.—Subsection (a) shall only apply to 
anticancer medication that is prescribed based on a find-
ing by the treating physician that the medication— 
‘‘(1) is medically necessary for the purpose of 
killing or slowing the growth of cancerous cells in a 
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manner that is in accordance with nationally accept-
ed standards of medical practice; 
‘‘(2) is clinically appropriate in terms of type, 
frequency, extent site, and duration; and 
‘‘(3) is not primarily for the convenience of the 
patient, physician, or other health care provider. 
‘‘(c) APPLICATION OF COST-SHARING AND RESTRIC-
TIONS.— 
‘‘(1) IN GENERAL.—The coverage of anticancer 
medication under subsection (a) may be subject to 
annual deductibles and coinsurance or copayments 
so long as such deductibles, coinsurance, and copay-
ments do not exceed the deductibles, coinsurance, 
and copayments that are applicable to intravenously 
administered or injected anticancer medications 
under the plan or coverage for the same purpose. 
‘‘(2) RESTRICTION.—A group health plan or 
health insurance issuer may not, in order to comply 
with the requirement of subsection (a)— 
‘‘(A) impose an increase in out-of-pocket 
costs with respect to anticancer medications; or 
‘‘(B) reclassify benefits with respect to 
anticancer medications. 
‘‘(d) APPLICATION
OF
NOTICE, PROHIBITIONS, 
ETC.—The provisions of subsections (b), (c), (d), and 
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provisions of such section shall be treated as also included 
under part B of title XXVII of the Public Health Service 
Act. 
(c) INTERNAL REVENUE CODE AMENDMENTS.— 
(1) IN
GENERAL.—Subchapter B of chapter 
100 of the Internal Revenue Code of 1986, as 
amended by subsection (f) of the section 1563 (relat-
ing to conforming amendments) of Public Law 111– 
148, is amended by adding at the end the following 
new section: 
‘‘SEC. 9816. PARITY IN COVERAGE FOR ORAL ANTICANCER 
DRUGS. 
‘‘(a) IN GENERAL.—Subject to subsection (b), a 
group health plan that provides benefits with respect to 
intravenously administered or injected anticancer medica-
tions shall provide for no less favorable coverage for pre-
scribed, orally administered anticancer medication that is 
used to kill or slow the growth of cancerous cells and that 
has been approved by the Food and Drug Administration. 
‘‘(b) LIMITATION.—Subsection (a) shall only apply to 
anticancer medication that is prescribed based on a find-
ing by the treating physician that the medication— 
‘‘(1) is medically necessary for the purpose of 
killing or slowing the growth of cancerous cells in a 
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manner that is in accordance with nationally accept-
ed standards of medical practice; 
‘‘(2) is clinically appropriate in terms of type, 
frequency, extent site, and duration; and 
‘‘(3) is not primarily for the convenience of the 
patient, physician, or other health care provider. 
‘‘(c) APPLICATION OF COST-SHARING AND RESTRIC-
TIONS.— 
‘‘(1) IN GENERAL.—The coverage of anticancer 
medication under subsection (a) may be subject to 
annual deductibles and coinsurance or copayments 
so long as such deductibles, coinsurance, and copay-
ments do not exceed the deductibles, coinsurance, 
and copayments that are applicable to intravenously 
administered or injected anticancer medications 
under the plan for the same purpose. 
‘‘(2) RESTRICTION.—A group health plan may 
not, in order to comply with the requirement of sub-
section (a)— 
‘‘(A) impose an increase in out-of-pocket 
costs with respect to anticancer medications; or 
‘‘(B) reclassify benefits with respect to 
anticancer medications. 
‘‘(d) APPLICATION
OF
NOTICE, PROHIBITIONS, 
ETC.—The provisions of subsections (b), (c), (d), and 
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(e)(2) of section 713 of the Employee Retirement and In-
come Security Act of 1974 shall apply with respect to the 
coverage required by subsection (a) in the same manner 
as they apply with respect to the coverage required under 
such section, except that January 1, 2012, shall be sub-
stituted for the date referred to in subsection (b)(3) of 
such section. 
‘‘(e) CONSTRUCTION.—Nothing in this section shall 
be construed— 
‘‘(1) to require the use of orally administered 
anticancer medications as a replacement for other 
anticancer medications; or 
‘‘(2) 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.’’. 
(2) CLERICAL AMENDMENT.—The table of sec-
tions for such subchapter is amended by adding at 
the end the following new items: 
‘‘Sec. 9815. Additional market reforms. 
‘‘Sec. 9816. Parity in coverage for oral anticancer drugs.’’. 
(d) CLARIFYING AMENDMENT REGARDING APPLICA-
TION
TO
GRANDFATHERED
PLANS.—Section 
1251(a)(4)(A) of the Patient Protection and Affordable 
Care 
Act 
(Public 
Law 
111–148; 
U.S.C. 
18011(a)(4)(A)), as added by section 2301(a) of Public 
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Law 111–152, is amended by adding at the end the fol-
lowing new clause: 
‘‘(v) Section 2729 (relating to stand-
ards relating to benefits for minor child’s 
congenital or developmental deformity or 
disorder), as added by section 2(b) of the 
Cancer Drug Coverage Parity Act of 
2011.’’. 
(e) 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, 2012, and 
with respect to health insurance coverage offered, sold, 
issued, renewed, in effect, or operated in the individual 
market on or after such date. 
(f) STUDY.—Not later than 2 years after the date 
of the enactment of this Act— 
(1) the Medicare Payment Advisory Commis-
sion shall complete a study that assesses how closing 
the Medicare part D donut hole under the amend-
ments made by section 3301 of the Patient Protec-
tion and Affordable Care Act (Public Law 111–148), 
as amended by section 1101 of the Health Care and 
Education Reconciliation Act of 2010 (Public Law 
111–152), affects Medicare coverage for orally ad-
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ministered anticancer medications, with a particular 
focus on cost and accessibility; and 
(2) submit a report to Congress on the results 
of such study. 
Æ 
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