Cancer Drug Parity Act of 2019

II 116TH CONGRESS 1ST SESSION S. 741 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 MARCH 12, 2019 Ms. SMITH (for herself, Mr. MORAN, Mr. MURPHY, and Mr. WICKER) intro- duced the following bill; which was read twice and referred to the Com- mittee 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 adminis- tered by a health care provider. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Cancer Drug Parity 4 Act of 2019’’. 5 VerDate Sep 11 2014 01:53 Mar 22, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S741.IS S741 kjohnson on DSK79L0C42 with BILLS 2 •S 741 IS SEC. 2. PARITY IN COST SHARING FOR ORAL ANTICANCER 1 DRUGS. 2 (a) REQUIREMENT.— 3 (1) IN GENERAL.—Section 2719A of the Public 4 Health Service Act (42 U.S.C. 300gg–19a) is 5 amended by adding at the end the following new 6 subsection: 7 ‘‘(e) PARITY IN COST SHARING FOR ORAL 8 ANTICANCER DRUGS.— 9 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 10 group health plan, and a health insurance issuer of- 11 fering group or individual health insurance coverage, 12 that provides benefits with respect to anticancer 13 medications administered by a health care provider 14 shall provide that any cost sharing for prescribed, 15 patient-administered anticancer medications that are 16 used to kill, slow, or prevent the growth of cancerous 17 cells and that have been approved by the Food and 18 Drug Administration is no less favorable than the 19 cost sharing for anticancer medications that is intra- 20 venously administered or injected by a health care 21 provider. 22 ‘‘(2) LIMITATION.—Paragraph (1) shall only 23 apply to an anticancer medication that is prescribed 24 based on a finding by the treating physician that the 25 medication— 26 VerDate Sep 11 2014 01:53 Mar 22, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S741.IS S741 kjohnson on DSK79L0C42 with BILLS 3 •S 741 IS ‘‘(A) is medically necessary for the purpose 1 of killing, slowing, or preventing the growth of 2 cancerous cells; or 3 ‘‘(B) is clinically appropriate in terms of 4 type, frequency, extent site, and duration. 5 ‘‘(3) RESTRICTION ON CERTAIN CHANGES.—A 6 group health plan or health insurance issuer may 7 not, in order to comply with the requirement of 8 paragraph (1), make changes to benefits or replace 9 existing benefits with new benefits under the plan or 10 health insurance coverage designed to have the effect 11 of— 12 ‘‘(A) imposing an increase in out-of-pocket 13 costs with respect to anticancer medications; 14 ‘‘(B) reclassifying benefits with respect to 15 anticancer medications in a way that would in- 16 crease such costs; or 17 ‘‘(C) applying more restrictive limitations 18 on prescribed orally administered anticancer 19 medications than on intravenously administered 20 or injected anticancer medications. 21 ‘‘(4) CONSTRUCTION.—Nothing in this sub- 22 section shall be construed— 23 VerDate Sep 11 2014 01:53 Mar 22, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S741.IS S741 kjohnson on DSK79L0C42 with BILLS 4 •S 741 IS ‘‘(A) to require the use of orally adminis- 1 tered anticancer medications as a replacement 2 for other anticancer medications; 3 ‘‘(B) to prohibit a group health plan or 4 health insurance issuer from requiring prior au- 5 thorization or imposing other appropriate utili- 6 zation controls in approving coverage for any 7 chemotherapy; or 8 ‘‘(C) to supersede a State law that pro- 9 vides greater protections with respect to the 10 coverage with respect to orally administered 11 anticancer medications than is provided under 12 this subsection. 13 ‘‘(5) COST SHARING DEFINED.—In this sub- 14 section, the term ‘cost sharing’ includes a deductible, 15 coinsurance, copayment, and any maximum limita- 16 tion on the application of such a deductible, coinsur- 17 ance, copayment, and similar out-of-pocket ex- 18 penses.’’. 19 (2) CONFORMING AMENDMENT.—Section 20 2724(c) of the Public Health Service Act (42 U.S.C. 21 300gg–23(c)) is amended by striking ‘‘section 2704’’ 22 and inserting ‘‘sections 2719A, 2725, and 2726’’. 23 (b) CLARIFYING AMENDMENT REGARDING APPLICA- 24 TION TO GRANDFATHERED PLANS.—Section 25 VerDate Sep 11 2014 01:53 Mar 22, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S741.IS S741 kjohnson on DSK79L0C42 with BILLS 5 •S 741 IS 1251(a)(4)(A) of the Patient Protection and Affordable 1 Care Act (42 U.S.C. 18011(a)(4)(A)) is amended by add- 2 ing at the end the following new clause: 3 ‘‘(v) Section 2719A(e) (relating to 4 cost sharing for oral anticancer drugs).’’. 5 (c) EFFECTIVE DATE.—The amendments made by 6 this section shall apply with respect to group health plans 7 for plan years beginning on or after January 1, 2020, and 8 with respect to health insurance coverage offered, sold, 9 issued, renewed, in effect, or operated in the individual 10 or group market on or after such date. 11 Æ VerDate Sep 11 2014 01:53 Mar 22, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\S741.IS S741 kjohnson on DSK79L0C42 with BILLS