119-hr4101

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4101 Introduced in House

    (IH) ]

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119th CONGRESS
 1st Session
 H. R. 4101

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

 June 24, 2025

 Mr. Grothman (for himself, Ms. Bonamici, Mr. Bilirakis, Mr. 
 Fitzpatrick, Mr. Morelle, Ms. Matsui, Ms. Brownley, Ms. Moore of 
 Wisconsin, Mr. Davis of North Carolina, Ms. Davids of Kansas, and Mr. 
 Wilson of South Carolina) introduced the following bill; which was 
 referred to the Committee on Education and 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 2025''.

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, 2026.

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.
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