Cancer Drug Parity Act of 2023

II 118TH CONGRESS 1ST SESSION S. 2039 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 SENATE OF THE UNITED STATES JUNE 15, 2023 Ms. SMITH (for herself, Mr. MORAN, Ms. BALDWIN, Mr. BLUMENTHAL, Mr. BROWN, Mrs. CAPITO, Mrs. HYDE-SMITH, Ms. KLOBUCHAR, Mr. KING, Mr. MERKLEY, Ms. MURKOWSKI, Mr. MURPHY, Mr. SCOTT of Florida, Mr. WHITEHOUSE, 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 Employee Retirement Income Security Act of 1974 to require a group health plan (or health insur- ance 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 Representa- 1 tives of the United States of America in Congress assembled, 2 VerDate Sep 11 2014 04:02 Jul 11, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S2039.IS S2039 kjohnson on DSK79L0C42PROD with BILLS 2 •S 2039 IS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Cancer Drug Parity 2 Act of 2023’’. 3 SEC. 2. PARITY IN COST-SHARING FOR ORAL ANTICANCER 4 DRUGS. 5 (a) IN GENERAL.—The Employee Retirement Income 6 Security Act of 1974 is amended by inserting after section 7 725 of such Act (29 U.S.C. 1185d) the following new sec- 8 tion: 9 ‘‘SEC. 726. PARITY IN COST-SHARING FOR ORAL 10 ANTICANCER DRUGS. 11 ‘‘(a) IN GENERAL.—Subject to subsection (b), a 12 group health plan (or health insurance coverage offered 13 in connection with such a plan) that provides benefits with 14 respect to anticancer medications administered by a health 15 care provider shall provide that any cost-sharing for pre- 16 scribed, patient-administered anticancer medications that 17 are used to kill, slow, or prevent the growth of cancerous 18 cells and that have been approved by the Food and Drug 19 Administration is no less favorable than the cost-sharing 20 for anticancer medications that is intravenously adminis- 21 tered or injected by a health care provider. 22 ‘‘(b) LIMITATION.—Subsection (a) shall only apply to 23 an anticancer medication that is prescribed based on a 24 finding by the treating physician that the medication— 25 VerDate Sep 11 2014 04:02 Jul 11, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S2039.IS S2039 kjohnson on DSK79L0C42PROD with BILLS 3 •S 2039 IS ‘‘(1) is medically necessary for the purpose of 1 killing, slowing, or preventing the growth of can- 2 cerous cells; or 3 ‘‘(2) is clinically appropriate in terms of type, 4 frequency, extent site, and duration. 5 ‘‘(c) RESTRICTION ON CERTAIN CHANGES.—A group 6 health plan (or health insurance coverage offered in con- 7 nection with such a plan) may not, in order to comply with 8 the requirement of subsection (a), make changes to bene- 9 fits or replace existing benefits with new benefits under 10 the plan (or health insurance coverage) designed to have 11 the effect of— 12 ‘‘(1) imposing an increase in out-of-pocket costs 13 with respect to anticancer medications; 14 ‘‘(2) reclassifying benefits with respect to 15 anticancer medications in a way that would increase 16 such costs; or 17 ‘‘(3) applying more restrictive limitations on 18 prescribed orally administered anticancer medica- 19 tions than on intravenously administered or injected 20 anticancer medications. 21 ‘‘(d) CONSTRUCTION.—Nothing in this section shall 22 be construed— 23 VerDate Sep 11 2014 04:02 Jul 11, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S2039.IS S2039 kjohnson on DSK79L0C42PROD with BILLS 4 •S 2039 IS ‘‘(1) to require the use of orally administered 1 anticancer medications as a replacement for other 2 anticancer medications; 3 ‘‘(2) to prohibit a group health plan (or health 4 insurance coverage offered in connection with such a 5 plan) from requiring prior authorization or imposing 6 other appropriate utilization controls in approving 7 coverage for any chemotherapy; or 8 ‘‘(3) to supersede a State law that provides 9 greater protections with respect to the coverage with 10 respect to orally administered anticancer medications 11 than is provided under this section. 12 ‘‘(e) COST-SHARING DEFINED.—In this section, the 13 term ‘cost-sharing’ includes a deductible, coinsurance, co- 14 payment, and any maximum limitation on the application 15 of such a deductible, coinsurance, copayment, and similar 16 out-of-pocket expenses.’’. 17 (b) TECHNICAL CORRECTION; CLERICAL CHANGE.— 18 The table of contents in section 1 of the Employee Retire- 19 ment Income Security Act of 1974 (29 U.S.C. 1001 et 20 seq.) is amended by inserting after the item relating to 21 section 725 the following new item: 22 ‘‘Sec. 726. Parity in cost-sharing for oral anticancer drugs.’’. (c) EFFECTIVE DATE.—The amendments made by 23 this section shall apply with respect to plan years begin- 24 ning on or after January 1, 2024. 25 VerDate Sep 11 2014 04:02 Jul 11, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S2039.IS S2039 kjohnson on DSK79L0C42PROD with BILLS 5 •S 2039 IS SEC. 3. GAO STUDY. 1 Not later than 2 years after the date of enactment 2 of this Act, the Comptroller General of the United States 3 shall— 4 (1) complete a study that assesses the impact 5 of section 726 of the Employee Retirement Income 6 Security Act of 1974, as added by section 2(a), on 7 the out-of-pocket costs associated with oral and pa- 8 tient-administered anticancer medications furnished 9 or dispensed to individuals enrolled in a group 10 health plan to which such section 726 applies, in 11 comparison to individuals enrolled in group health 12 plans or health insurance coverage to which section 13 726 does not apply, including any recommendations 14 or matters for congressional consideration regarding 15 actions Federal agencies or Congress can take to re- 16 duce financial barriers to access to oral and patient- 17 administered anticancer medications; and 18 (2) submit to Congress a report on the results 19 of such study, including recommendations or matters 20 for congressional consideration to improve access to 21 oral and patient-administered anticancer medications 22 for individuals enrolled in group health plans and 23 group or individual health insurance coverage of- 24 fered by a health insurance issuer. 25 Æ VerDate Sep 11 2014 04:02 Jul 11, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6301 E:\BILLS\S2039.IS S2039 kjohnson on DSK79L0C42PROD with BILLS