This bill amends the Public Health Service Act to require a group or individual health plan that covers anticancer medications administered by a health care provider to provide no less favorable coverage for anticancer medications administered by a patient. A plan may apply to patient-administered anticancer medications only the cost-sharing and limitations that apply to anticancer medications administered by a health care provider.
These requirements apply to medication approved by the Food and Drug Administration that is prescribed based on a finding by the treating physician that the medication is medically necessary for cancer treatment and is clinically appropriate in terms of type, frequency, extent site, and duration.
To comply with these requirements, health plans may not, for anticancer medications: (1) change or replace benefits to increase out-of-pocket costs; (2) reclassify benefits to increase costs; or (3) apply more restrictive limitations to orally administered medications than to intravenously administered or injected medications.]]>