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[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6301 Introduced in House (IH)]
<DOC>
118th CONGRESS
1st Session
H. R. 6301
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
November 8, 2023
Mr. Grothman (for himself, Ms. Bonamici, Mr. Bilirakis, Mr. Higgins of
New York, Mr. Fitzpatrick, Mr. Morelle, and Ms. Matsui) introduced the
following bill; which was referred to the Committee on Education and
the Workforce
_______________________________________________________________________
A BILL
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 2023''.
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, 2024.
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 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.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Education and the Workforce.
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