Cancer Drug Parity Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 1730 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 HOUSE OF REPRESENTATIVES MARCH 13, 2019 Mr. HIGGINS of New York (for himself, Mr. GUTHRIE, Ms. MATSUI, Mr. BILI- RAKIS, Mr. KILMER, Mr. FITZPATRICK, Mr. KING of New York, Mr. NADLER, Mr. DEFAZIO, Mr. HASTINGS, Mr. OLSON, Ms. WASSERMAN SCHULTZ, Mr. HURD of Texas, Mr. BERA, Mr. COLE, Mr. KHANNA, Mr. MCCAUL, and Ms. NORTON) introduced the following bill; which was re- ferred to the Committee on Energy and Commerce 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 VerDate Sep 11 2014 00:44 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H1730.IH H1730 pamtmann on DSKBFK8HB2PROD with BILLS 2 •HR 1730 IH SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Cancer Drug Parity 2 Act of 2019’’. 3 SEC. 2. PARITY IN COST SHARING FOR ORAL ANTICANCER 4 DRUGS. 5 (a) REQUIREMENT.— 6 (1) IN GENERAL.—Section 2719A of the Public 7 Health Service Act (42 U.S.C. 300gg–19a) is 8 amended by adding at the end the following new 9 subsection: 10 ‘‘(e) PARITY IN COST SHARING FOR ORAL 11 ANTICANCER DRUGS.— 12 ‘‘(1) IN GENERAL.—Subject to paragraph (2), a 13 group health plan, and a health insurance issuer of- 14 fering group or individual health insurance coverage, 15 that provides benefits with respect to anticancer 16 medications administered by a health care provider 17 shall provide that any cost sharing for prescribed, 18 patient-administered anticancer medications that are 19 used to kill, slow, or prevent the growth of cancerous 20 cells and that have been approved by the Food and 21 Drug Administration is no less favorable than the 22 cost sharing for anticancer medications that is intra- 23 venously administered or injected by a health care 24 provider. 25 VerDate Sep 11 2014 00:44 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H1730.IH H1730 pamtmann on DSKBFK8HB2PROD with BILLS 3 •HR 1730 IH ‘‘(2) LIMITATION.—Paragraph (1) shall only 1 apply to an anticancer medication that is prescribed 2 based on a finding by the treating physician that the 3 medication— 4 ‘‘(A) is medically necessary for the purpose 5 of killing, slowing, or preventing the growth of 6 cancerous cells; or 7 ‘‘(B) is clinically appropriate in terms of 8 type, frequency, extent site, and duration. 9 ‘‘(3) RESTRICTION ON CERTAIN CHANGES.—A 10 group health plan or health insurance issuer may 11 not, in order to comply with the requirement of 12 paragraph (1), make changes to benefits or replace 13 existing benefits with new benefits under the plan or 14 health insurance coverage designed to have the effect 15 of— 16 ‘‘(A) imposing an increase in out-of-pocket 17 costs with respect to anticancer medications; 18 ‘‘(B) reclassifying benefits with respect to 19 anticancer medications in a way that would in- 20 crease such costs; or 21 ‘‘(C) applying more restrictive limitations 22 on prescribed orally administered anticancer 23 medications than on intravenously administered 24 or injected anticancer medications. 25 VerDate Sep 11 2014 00:44 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H1730.IH H1730 pamtmann on DSKBFK8HB2PROD with BILLS 4 •HR 1730 IH ‘‘(4) CONSTRUCTION.—Nothing in this sub- 1 section shall be construed— 2 ‘‘(A) to require the use of orally adminis- 3 tered anticancer medications as a replacement 4 for other anticancer medications; 5 ‘‘(B) to prohibit a group health plan or 6 health insurance issuer from requiring prior au- 7 thorization or imposing other appropriate utili- 8 zation controls in approving coverage for any 9 chemotherapy; or 10 ‘‘(C) to supersede a State law that pro- 11 vides greater protections with respect to the 12 coverage with respect to orally administered 13 anticancer medications than is provided under 14 this subsection. 15 ‘‘(5) COST SHARING DEFINED.—In this sub- 16 section, the term ‘cost sharing’ includes a deductible, 17 coinsurance, copayment, and any maximum limita- 18 tion on the application of such a deductible, coinsur- 19 ance, copayment, and similar out-of-pocket ex- 20 penses.’’. 21 (2) CONFORMING AMENDMENT.—Section 22 2724(c) of the Public Health Service Act (42 U.S.C. 23 300gg–23(c)) is amended by striking ‘‘section 2704’’ 24 and inserting ‘‘sections 2719A, 2725, and 2726’’. 25 VerDate Sep 11 2014 00:44 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H1730.IH H1730 pamtmann on DSKBFK8HB2PROD with BILLS 5 •HR 1730 IH (b) CLARIFYING AMENDMENT REGARDING APPLICA- 1 TION TO GRANDFATHERED PLANS.—Section 2 1251(a)(4)(A) of the Patient Protection and Affordable 3 Care Act (42 U.S.C. 18011(a)(4)(A)) is amended by add- 4 ing at the end the following new clause: 5 ‘‘(v) Section 2719A(e) (relating to 6 cost sharing for oral anticancer drugs).’’. 7 (c) EFFECTIVE DATE.—The amendments made by 8 this section shall apply with respect to group health plans 9 for plan years beginning on or after January 1, 2020, and 10 with respect to health insurance coverage offered, sold, 11 issued, renewed, in effect, or operated in the individual 12 or group market on or after such date. 13 Æ VerDate Sep 11 2014 00:44 Mar 23, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\H1730.IH H1730 pamtmann on DSKBFK8HB2PROD with BILLS