I 111th CONGRESS 1st Session H. R. 2366 IN THE HOUSE OF REPRESENTATIVES May 12, 2009 Mr. Higgins introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committees on Education and Labor and Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned A BILL To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans to provide for coverage of oral cancer drugs on terms no less favorable than the coverage provided for intravenously administered anticancer medications.

1.

Short title

This Act may be cited as the Cancer Drug Coverage Parity Act of 2009.

2.

Parity in coverage for oral cancer drugs

(a)

Group health plans

(1)

ERISA

(A)The Employee Retirement Income Security Act of 1974 is amended by inserting after section 714 the following new section:

715.

Parity in coverage for oral cancer drugs

(a)

In general

A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, that provides benefits with respect to intravenously administered or injected cancer medications shall provide for no less favorable coverage for prescribed, orally administered anticancer medication used to kill or slow the growth of cancerous cells. The coverage for such medication may be subject to annual deductibles and coinsurance provisions as may be applicable to intravenously administered or injected cancer medications under the plan or coverage. Written notice of the availability of such coverage shall be delivered to participants upon enrollment and annually thereafter. (b)

Application of notice, prohibitions, etc

The provisions of subsections (b), (c), (d), and (e)(2) of section 713 shall apply with respect to the coverage required by subsection (a) in the same manner as they apply with respect to the coverage required under such section.

. (B)The table of contents of such Act is amended by inserting after the item relating to section 714 the following new item: Sec. 715. Parity in coverage for oral cancer drugs. . (2)

PHSA

Title XXVII of the Public Health Service Act is amended by inserting after section 2707 the following new section:

2708.

Parity in coverage for oral cancer drugs

(a)

In general

A group health plan, and a health insurance issuer providing health insurance coverage in connection with a group health plan, that provides benefits with respect to intravenously administered or injected cancer medications shall provide for no less favorable coverage for prescribed, orally administered anticancer medication used to kill or slow the growth of cancerous cells. The coverage for such medication may be subject to annual deductibles and coinsurance provisions as may be applicable to intravenously administered or injected cancer medications under the plan or coverage. Written notice of the availability of such coverage shall be delivered to participants upon enrollment and annually thereafter. (b)

Application of notice, prohibitions, etc

The provisions of subsections (b), (c), (d), and (e)(2) of section 713 of the Employee Retirement Income Security Act of 1974 shall apply with respect to the coverage required by subsection (a) in the same manner as they apply with respect to the coverage required under such section.

. (3)

IRC

(A)Subchapter B of chapter 100 of the Internal Revenue Code of 1986 is amended by adding at the end the following new section:

9813.

Parity in coverage for oral cancer drugs

(a)

In general

A group health plan that provides benefits with respect to intravenously administered or injected cancer medications shall provide for no less favorable coverage for prescribed, orally administered anticancer medication used to kill or slow the growth of cancerous cells. The coverage for such medication may be subject to annual deductibles and coinsurance provisions as may be applicable to intravenously administered or injected cancer medications under the plan. Written notice of the availability of such coverage shall be delivered to participants upon enrollment and annually thereafter. (b)

Application of notice, prohibitions, etc

The provisions of subsections (b), (c), (d), and (e)(2) of section 713 of the Employee Retirement Income Security Act of 1974 shall apply with respect to the coverage required by subsection (a) in the same manner as they apply with respect to the coverage required under such section.

. (B)The table of sections for such subchapter is amended by adding at the end the following new item: 9813. Parity in coverage for oral cancer drugs. . (b)

Individual health insurance coverage

Title XXVII of the Public Health Service Act is amended by inserting after section 2753 the following new section:

2754.

Parity in coverage for oral cancer drugs

The provisions of section 2708 shall apply to health insurance coverage offered by a health insurance issuer in the individual market in the same manner as they apply to health insurance coverage offered by a health insurance issuer in connection with a group health plan in the small or large group market.

. (c)

Effective date

(1)

Group health plans

The amendments made by subsection (a) shall apply with respect to group health plans for plan years beginning after the date that is 1 year after the date of enactment of this Act. (2)

Individual health insurance coverage

The amendment made by subsection (b) shall apply with respect to health insurance coverage offered, sold, issued, renewed, in effect, or operated in the individual market after the date that is 1 year after the date of enactment of this Act.