Cancer Drug Parity Act of 2021
Bill: H.R.4385 | Sponsor: Rep. Higgins, Brian (D-NY)
Policy area: Health

Summary:
Cancer Drug Parity Act of 2021
This bill requires group health plans that cover anticancer medications administered by a health care provider to provide no less favorable cost sharing for patient-administered anticancer medications. This requirement applies to medications that are (1) approved by the Food and Drug Administration; (2) medically necessary for the cancer treatment; and (3) clinically appropriate in terms of type, frequency, extent site, and duration.
To comply with this requirement, plans may not, with respect to 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.


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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Cancer Drug Parity Act of 2021''.

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 section:

``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 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 is no 
less favorable than the cost sharing for anticancer medications that is 
intravenously administered 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--
            ``(1) is medically necessary for the purpose of killing, 
        slowing, or preventing the growth of cancerous 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 connection with such a plan) may 
not, in order to comply with the requirement of subsection (a), make 
changes to benefits 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 medications than on 
        intravenously administered or injected anticancer medications.
    ``(d) 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;
            ``(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, copayment, 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 Retirement 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 beginning on or after January 1, 2022.

SEC. 3. GAO STUDY.

    Not later than 24 months after the date of the 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 patient-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 
        reduce 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 offered by a health insurance issuer.
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