Sponsors (28)
The bill creates immediate parity that lowers out‑of‑pocket costs and brings predictability for many patients using oral anticancer drugs, while shifting costs and administrative burdens onto plans/employers and relying on a future GAO study for broader fixes that may take up to two years to act on.
Patients prescribed oral anticancer drugs will have parity with infused/injected cancer drugs—no higher deductibles, copays, or coinsurance—reducing out‑of‑pocket costs and improving access to prescribed oral treatments.
People taking oral anticancer medications gain financial predictability because plans cannot reclassify benefits or add limits to shift costs onto patients.
The bill directs a GAO study with a two-year deadline to produce evidence-based recommendations to reduce financial barriers for oral and patient‑administered anticancer drugs, giving Congress a targeted basis and timeline to pursue further reforms.
Employers and insurers may face higher prescription coverage costs, which could lead to higher premiums or reduced benefits for workers and families.
Insurers might increase use of prior authorization or other utilization controls, causing delays or denials for some patients and slowing access to prescribed oral treatments.
The GAO study does not change coverage immediately—patients may wait up to two years for any recommended policy changes, so near‑term financial barriers for some enrollees remain.
Based on analysis of 3 sections of legislative text.
Requires group health plans to apply equal cost‑sharing to FDA‑approved oral anticancer drugs and infused/injected anticancer drugs, barring plans from increasing patient costs to evade parity.
Introduced June 24, 2025 by Glenn Grothman · Last progress June 24, 2025
Requires group health plans and health insurance sold in connection with group plans to treat FDA‑approved, patient‑administered (oral) anticancer medications the same as infused or injected anticancer medications for cost‑sharing. Plans cannot raise out‑of‑pocket costs, reclassify benefits, or apply more restrictive cost limits to oral anticancer drugs; they may still use medical necessity checks and prior authorization. The rule applies to plan years starting on or after January 1, 2026, and directs the GAO to study the law's effects on out‑of‑pocket costs and offer recommendations within two years of enactment.