I 
119TH CONGRESS 
1ST SESSION H. R. 4101 
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 
JUNE 24, 2025 
Mr. GROTHMAN
(for himself, Ms. BONAMICI, Mr. BILIRAKIS, Mr. 
FITZPATRICK, Mr. MORELLE, Ms. MATSUI, Ms. BROWNLEY, Ms. MOORE 
of Wisconsin, Mr. DAVIS of North Carolina, Ms. DAVIDS of Kansas, and 
Mr. WILSON of South Carolina) introduced the following bill; which was 
referred to the Committee on Education and Workforce 
A BILL 
To amend the Employee Retirement Income Security Act 
of 1974 to require a group health plan (or health insur-
ance 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. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
VerDate Sep 11 2014 
03:44 Jun 29, 2025
Jkt 059200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6201
E:\BILLS\H4101.IH
H4101
kjohnson on DSK7ZCZBW3PROD with $$_JOB
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Cancer Drug Parity 
Act of 2025’’. 
SEC. 2. PARITY IN COST-SHARING FOR ORAL ANTICANCER 
DRUGS. 
(a) IN GENERAL.—The Employee Retirement Income 
Security Act of 1974 is amended by inserting after section 
725 of such Act (29 U.S.C. 1185d) the following new sec-
tion: 
‘‘SEC. 
726. 
PARITY 
IN 
COST-SHARING 
FOR 
ORAL 
ANTICANCER DRUGS. 
‘‘(a) IN GENERAL.—Subject to subsection (b), a 
group health plan (or health insurance coverage offered 
in connection with such a plan) that provides benefits with 
respect to anticancer medications administered by a health 
care provider shall provide that any cost-sharing for pre-
scribed, patient-administered anticancer medications that 
are used to kill, slow, or prevent the growth of cancerous 
cells and that have been approved by the Food and Drug 
Administration is no less favorable than the cost-sharing 
for anticancer medications that is intravenously adminis-
tered or injected by a health care provider. 
‘‘(b) LIMITATION.—Subsection (a) shall only apply to 
an anticancer medication that is prescribed based on a 
finding by the treating physician that the medication— 
VerDate Sep 11 2014 
03:44 Jun 29, 2025
Jkt 059200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H4101.IH
H4101
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(1) is medically necessary for the purpose of 
killing, slowing, or preventing the growth of can-
cerous cells; or 
‘‘(2) is clinically appropriate in terms of type, 
frequency, extent site, and duration. 
‘‘(c) RESTRICTION ON CERTAIN CHANGES.—A group 
health plan (or health insurance coverage offered in con-
nection with such a plan) may not, in order to comply with 
the requirement of subsection (a), make changes to bene-
fits or replace existing benefits with new benefits under 
the plan (or health insurance coverage) designed to have 
the effect of— 
‘‘(1) imposing an increase in out-of-pocket costs 
with respect to anticancer medications; 
‘‘(2) reclassifying benefits with respect to 
anticancer medications in a way that would increase 
such costs; or 
‘‘(3) applying more restrictive limitations on 
prescribed orally administered anticancer medica-
tions than on intravenously administered or injected 
anticancer medications. 
‘‘(d) CONSTRUCTION.—Nothing in this section shall 
be construed— 
VerDate Sep 11 2014 
03:44 Jun 29, 2025
Jkt 059200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H4101.IH
H4101
kjohnson on DSK7ZCZBW3PROD with $$_JOB
‘‘(1) to require the use of orally administered 
anticancer medications as a replacement for other 
anticancer medications; 
‘‘(2) to prohibit a group health plan (or health 
insurance coverage offered in connection with such a 
plan) from requiring prior authorization or imposing 
other appropriate utilization controls in approving 
coverage for any chemotherapy; or 
‘‘(3) to supersede a State law that provides 
greater protections with respect to the coverage with 
respect to orally administered anticancer medications 
than is provided under this section. 
‘‘(e) COST-SHARING DEFINED.—In this section, the 
term ‘cost-sharing’ includes a deductible, coinsurance, co-
payment, and any maximum limitation on the application 
of such a deductible, coinsurance, copayment, and similar 
out-of-pocket expenses.’’. 
(b) TECHNICAL CORRECTION; CLERICAL CHANGE.— 
The table of contents in section 1 of the Employee Retire-
ment Income Security Act of 1974 (29 U.S.C. 1001 et 
seq.) is amended by inserting after the item relating to 
section 725 the following new item: 
‘‘Sec. 726. Parity in cost-sharing for oral anticancer drugs.’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply with respect to plan years begin-
ning on or after January 1, 2026. 
VerDate Sep 11 2014 
03:44 Jun 29, 2025
Jkt 059200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H4101.IH
H4101
kjohnson on DSK7ZCZBW3PROD with $$_JOB
SEC. 3. GAO STUDY. 
Not later than 2 years after the date of enactment 
of this Act, the Comptroller General of the United States 
shall— 
(1) complete a study that assesses the impact 
of section 726 of the Employee Retirement Income 
Security Act of 1974, as added by section 2(a), on 
the out-of-pocket costs associated with oral and pa-
tient-administered anticancer medications furnished 
or dispensed to individuals enrolled in a group 
health plan to which such section 726 applies, in 
comparison to individuals enrolled in group health 
plans or health insurance coverage to which section 
726 does not apply, including any recommendations 
or matters for congressional consideration regarding 
actions Federal agencies or Congress can take to re-
duce financial barriers to access to oral and patient- 
administered anticancer medications; and 
(2) submit to Congress a report on the results 
of such study, including recommendations or matters 
for congressional consideration to improve access to 
oral and patient-administered anticancer medications 
for individuals enrolled in group health plans and 
group or individual health insurance coverage of-
fered by a health insurance issuer. 
Æ 
VerDate Sep 11 2014 
03:44 Jun 29, 2025
Jkt 059200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6301
E:\BILLS\H4101.IH
H4101
kjohnson on DSK7ZCZBW3PROD with $$_JOB