Title: Cancer Drug Parity Act of 2018
Policy area: Health

Summary:
Cancer Drug Coverage Act of 2018
This bill requires 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.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3742 Introduced in Senate (IS)]

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115th CONGRESS
  2d Session
                                S. 3742

To amend the Public Health Service Act to require group and individual 
 health insurance coverage and group health plans 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 SENATE OF THE UNITED STATES

                           December 12, 2018

    Ms. Smith (for herself, Mr. Moran, Mr. Murphy, and Mr. Wicker) 
introduced the following bill; which was read twice and referred to the 
          Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act to require group and individual 
 health insurance coverage and group health plans 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 2018''.

SEC. 2. PARITY IN COST SHARING 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 Cost Sharing for Oral Anticancer Drugs.--
            ``(1) In general.--Subject to paragraph (2), a group health 
        plan, and a health insurance issuer offering group or 
        individual health insurance coverage, 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.
            ``(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;
                    ``(B) reclassifying benefits with respect to 
                anticancer medications in a way that would increase 
                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 subsection shall be 
        construed--
                    ``(A) to require the use of orally administered 
                anticancer medications as a replacement for other 
                anticancer medications;
                    ``(B) 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; or
                    ``(C) 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 subsection.
            ``(5) Cost sharing defined.--In this subsection, 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.''.
            (2) Conforming amendment.--Section 2724(c) of the Public 
        Health Service Act (42 U.S.C. 300gg-23(c)) is amended by 
        striking ``section 2704'' and inserting ``sections 2719A, 2725, 
        and 2726''.
    (b) Clarifying Amendment Regarding Application 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 adding at the end the 
following new clause:
                            ``(v) Section 2719A(e) (relating to cost 
                        sharing for oral anticancer drugs).''.
    (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, 2019, 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.
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