Sponsors (28)
Official title: 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.
Introduced June 24, 2025 by Glenn Grothman · Last progress June 24, 2025
The bill reduces out‑of‑pocket costs and creates predictability for patients taking oral anticancer drugs while preserving cost‑management tools and producing a GAO study for further action — but it may raise costs for employers, insurers, and potentially taxpayers, risk delays in patient access via utilization controls, and imposes near‑term implementation burdens.
Patients prescribed oral anticancer drugs will no longer face higher deductibles, copays, or coinsurance than for equivalent infused/injected cancer drugs, and plans cannot reclassify benefits or add limits to shift costs onto these patients, reducing out‑of‑pocket cancer treatment costs and increasing financial predictability.
The GAO study and two-year deadline will give Congress evidence-based findings and a clear timeline to consider targeted policy fixes that could further reduce financial barriers to oral and patient‑administered anticancer drugs.
Insurers and employers retain utilization-management tools (e.g., prior authorization), preserving mechanisms to manage appropriate clinical use and control overall plan costs.
Employers and insurers will likely face higher prescription coverage costs to meet parity requirements, which could lead to higher premiums for workers and families or reductions in other benefits.
Patients may still experience slower access to needed oral anticancer drugs because plans can use prior authorization more often to control utilization, and the GAO study/process means any broader coverage changes could take up to two years—so many patients see no immediate relief.
If Congress acts on GAO recommendations, implementing those changes could require federal spending or regulatory shifts that raise costs for insurers or taxpayers.
Based on analysis of 3 sections of legislative text.
Requires group plans and group health insurance to apply equal cost‑sharing to oral anticancer drugs and infused/injected anticancer drugs starting with plan years on or after Jan 1, 2026.
Requires group health plans and large‑group health insurance to treat orally administered, patient‑administered FDA‑approved anticancer drugs the same as infused or injected anticancer drugs for cost‑sharing purposes. Plans cannot shift costs or apply more restrictive limits to oral anticancer drugs, but may continue to require prior authorization and make medical‑necessity determinations; the rule applies to plan years beginning on or after January 1, 2026. The bill also directs the GAO to study and report within two years on how the new rule affects out‑of‑pocket costs and to recommend ways to reduce financial barriers to cancer medicines.