I 
114TH CONGRESS 
1ST SESSION H. R. 2739 
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 pro-
vider. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 11, 2015 
Mr. LANCE (for himself, Mr. HIGGINS, Mr. FITZPATRICK, Mr. SMITH of New 
Jersey, Ms. CLARK of Massachusetts, Ms. SCHAKOWSKY, Mr. YARMUTH, 
Mr. HASTINGS, Mr. ISRAEL, Mr. DENT, Mr. KING of New York, and Mr. 
SENSENBRENNER) introduced the following bill; which was referred to the 
Committee on Energy and Commerce 
A BILL 
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 pro-
vided 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, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Cancer Drug Coverage 
Parity Act of 2015’’. 
SEC. 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) is 
amended by adding at the end the following new 
subsection: 
‘‘(e) PARITY IN COVERAGE FOR ORAL ANTICANCER 
DRUGS.— 
‘‘(1) IN GENERAL.—Subject to paragraph (2), a 
group health plan, and a health insurance issuer of-
fering 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-ad-
ministered 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 pro-
vider; and 
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‘‘(B) not subject to any prior authoriza-
tion, step therapy, dollar or durational limit, co-
payment, 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; 
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‘‘(B) reclassifying benefits with respect to 
anticancer medications in a way that would in-
crease 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 sub-
section shall be construed— 
‘‘(A) to require the use of orally adminis-
tered anticancer medications as a replacement 
for other anticancer medications; 
‘‘(B) to prohibit a group health plan or 
health insurance issuer from requiring prior au-
thorization or imposing other appropriate utili-
zation controls in approving coverage for any 
chemotherapy; or 
‘‘(C) to supersede a State law that pro-
vides 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. 
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300gg–23(c)) is amended by striking ‘‘section 2704’’ 
and inserting ‘‘sections 2719A, 2725, and 2726’’. 
(b) CLARIFYING AMENDMENT REGARDING APPLICA-
TION
TO
GRANDFATHERED
PLANS.—Section 
1251(a)(4)(A) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18011(a)(4)(A)) is amended by add-
ing at the end the following new clause: 
‘‘(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. 
Æ 
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