Sponsors (29)
The bill establishes parity so oral anticancer drugs cost patients no more than infused drugs and preserves state protections and insurer tools, improving financial predictability for cancer patients but likely raising costs for employers/insurers (with possible higher premiums or reduced benefits) and risking access delays from increased utilization controls while relying on a two‑year GAO study for further policy changes.
People prescribed oral anticancer drugs will no longer face higher deductibles, copays, or coinsurance than for equivalent infused/injected cancer drugs, reducing out‑of‑pocket costs and preventing plans from reclassifying benefits or adding limits to shift costs onto patients.
A GAO study with a two-year deadline will provide evidence-based recommendations on whether further federal action could reduce cost-sharing for oral and patient‑administered anticancer drugs, giving Congress a focused path for targeted fixes.
Insurers and employers retain utilization-management tools (e.g., prior authorization), preserving their ability to manage appropriate clinical use and control plan costs.
Employers and insurers will likely face higher prescription coverage costs to comply with parity, which could lead to higher premiums or reduced benefits for workers and families.
Some patients could experience slower access to prescribed oral anticancer treatments if plans increase use of prior authorization or other utilization controls, causing delays or denials.
Plans and employers must revise benefit designs and systems by January 1, 2026, imposing administrative burdens and short-term compliance costs.
Based on analysis of 3 sections of legislative text.
Requires group health plans to apply the same patient cost‑sharing to prescribed oral anticancer drugs as to infused/injected anticancer drugs, effective for plan years starting Jan 1, 2026; GAO study required.
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
Requires group health plans and group health insurance to apply the same patient cost-sharing for prescribed, patient‑administered (oral) FDA‑approved anticancer medications as for anticancer medications given by infusion or injection, while allowing medical-necessity exceptions and prior authorization. It bars plans from sidestepping parity by raising out‑of‑pocket limits or reclassifying benefits and defers to stronger State law protections. Directs the Government Accountability Office to study within two years how the new rule affects out‑of‑pocket costs for oral anticancer drugs versus infused/injected drugs and to report recommendations to Congress to reduce financial barriers to access.