I 
113TH CONGRESS 
1ST SESSION H. R. 1801 
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 anticancer medications administered 
by a health care provider. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 26, 2013 
Mr. HIGGINS (for himself, Ms. MOORE, Ms. PINGREE of Maine, Mr. 
CICILLINE, Mrs. CAPPS, Mr. GRIJALVA, Ms. WILSON of Florida, Mr. 
HASTINGS of Florida, Mr. KING of New York, Mr. RANGEL, Mr. LARSEN 
of Washington, Mr. MCGOVERN, Mr. PETERS of California, Mr. WOLF, 
Mr. MORAN, and Mr. FARR) introduced the following bill; which was re-
ferred 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 
anticancer medications administered by a health care 
provider. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Cancer Drug Coverage 
Parity Act of 2013’’. 
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 
anticancer medications administered by a health care pro-
vider shall provide for no less favorable coverage 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. 
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‘‘(C) apply more restrictive limitations on 
prescribed orally-administered anticancer medi-
cations or intravenously administered or in-
jected anticancer medications. 
‘‘(d) APPLICATION
OF
NOTICE, PROHIBITIONS, 
ETC.—The provisions of subsections (b), (c), (d), and 
(e)(2) of section 713 shall apply with respect to the cov-
erage required by subsection (a) in the same manner as 
they apply with respect to the coverage required under 
such section, except that January 1, 2014, 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) Section 731(c) of such Act (29 U.S.C. 1191(c)) 
is amended by striking ‘‘section 711’’ and inserting ‘‘sec-
tions 711 and 716’’. 
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(3) Section 732(a) of such Act (29 U.S.C. 1191a(a)) 
is amended by striking ‘‘section 711’’ and inserting ‘‘sec-
tions 711 and 716’’. 
(4) The table of contents in section 1 of such Act 
is amended by inserting after the item relating to section 
714 the following new items: 
‘‘Sec. 715. Additional market reforms. 
‘‘Sec. 716. Parity in coverage for oral anticancer drugs.’’. 
(b) PUBLIC HEALTH SERVICE ACT AMENDMENTS.— 
(1) Title XXVII of the Public Health Service Act is 
amended by inserting after section 2728 (42 U.S.C. 
300gg–28), as redesignated by section 1001(2) of the Pa-
tient Protection and Affordable Care Act (Public Law 
111–148), the following new section: 
‘‘SEC. 2729. PARITY IN COVERAGE FOR ORAL ANTICANCER 
DRUGS. 
‘‘(a) IN GENERAL.—Subject to subsection (b), a 
group health plan, and a health insurance issuer offering 
health insurance coverage, that provides benefits with re-
spect to anticancer medications administered by a health 
care provider shall provide for no less favorable coverage 
for prescribed, patient-administered anticancer medica-
tions that are used to kill, slow, or prevent the growth 
of cancerous cells and that have been approved by the 
Food and Drug Administration. 
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‘‘(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— 
‘‘(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) 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 anticancer 
medications administered by a health care provider 
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; 
‘‘(B) reclassify benefits with respect to 
anticancer medications; or 
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‘‘(C) apply more restrictive limitations on 
prescribed orally-administered anticancer medi-
cations or intravenously administered or in-
jected anticancer medications. 
‘‘(d) APPLICATION
OF
NOTICE, PROHIBITIONS, 
ETC.—The provisions of subsections (b), (c), (d), and 
(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, 2014, 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) Section 2724(c) of such Act (42 U.S.C. 300gg– 
23(c)), as redesignated by section 1001(4) and subsection 
(c)(14) of the section 1563 (relating to conforming amend-
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ments) of Public Law 111–148, is amended by striking 
‘‘section 2704’’ and inserting ‘‘sections 2725 and 2729’’. 
(3) Section 2762(b)(2) of such Act (42 U.S.C. 
300gg–62(b)(2)) is amended by striking ‘‘section 2751’’ 
and inserting ‘‘sections 2751 and 2729’’. 
(4) For purposes of applying section 2729 of the 
Public Health Service Act, as inserted by paragraph (1), 
to individual health insurance coverage before 2014, the 
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 
anticancer medications administered by a health care pro-
vider shall provide for no less favorable coverage for pre-
scribed, patient-administered anticancer medications that 
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are used to kill, slow, or prevent the growth of cancerous 
cells and that have been approved by the Food and Drug 
Administration. 
‘‘(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— 
‘‘(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) 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 anticancer 
medications administered by a health care provider 
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)— 
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‘‘(A) impose an increase in out-of-pocket 
costs with respect to anticancer medications; 
‘‘(B) reclassify benefits with respect to 
anticancer medications; or 
‘‘(C) apply more restrictive limitations on 
prescribed orally-administered anticancer medi-
cations or intravenously administered or in-
jected anticancer medications. 
‘‘(d) APPLICATION
OF
NOTICE, PROHIBITIONS, 
ETC.—The provisions of subsections (b), (c), (d), and 
(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, 2014, 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 
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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 
Law 111–152, is amended by adding at the end the fol-
lowing new clause: 
‘‘(v) Section 2729, as added by sec-
tion 2(b) of the Cancer Drug Coverage 
Parity Act of 2013.’’. 
(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, 2014, 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— 
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(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-
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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