[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 1566 Introduced in Senate (IS)]

114th CONGRESS
  1st Session
                                S. 1566

To amend the Public Health Service Act to require group and individual 
    health insurance coverage and group health plans to provide for 
 coverage of oral anticancer drugs on terms no less favorable than the 
 coverage provided for anticancer medications administered by a health 
                             care provider.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 11, 2015

 Mr. Kirk (for himself and Mr. Franken) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act to require group and individual 
    health insurance coverage and group health plans to provide for 
 coverage of oral anticancer drugs on terms no less favorable than the 
 coverage provided for anticancer medications administered by a health 
                             care provider.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Cancer Drug Coverage Parity Act of 
2015''.

SEC. 2. PARITY IN COVERAGE FOR ORAL ANTICANCER DRUGS.

    (a) Requirement.--
            (1) In general.--Section 2719A of the Public Health Service 
        Act (42 U.S.C. 300gg-19a) is amended by adding at the end the 
        following new subsection:
    ``(e) Parity in Coverage for Oral Anticancer Drugs.--
            ``(1) In general.--Subject to paragraph (2), a group health 
        plan, and a health insurance issuer offering group or 
        individual health insurance coverage, that provides benefits 
        with respect to anticancer medications administered by a health 
        care provider shall provide for coverage for prescribed, 
        patient-administered anticancer medications that are used to 
        kill, slow, or prevent the growth of cancerous cells and that 
        have been approved by the Food and Drug Administration that 
        is--
                    ``(A) no less favorable than the coverage for 
                anticancer medications that are intravenously 
                administered or injected by a health care provider; and
                    ``(B) not subject to any prior authorization, step 
                therapy, dollar or durational limit, copayment, 
                deductible or coinsurance that does not apply to such 
                provider-administered anticancer medications.
            ``(2) Limitation.--Paragraph (1) shall only apply to an 
        anticancer medication that is prescribed based on a finding by 
        the treating physician that the medication--
                    ``(A) is medically necessary for the purpose of 
                killing, slowing, or preventing the growth of cancerous 
                cells; or
                    ``(B) is clinically appropriate in terms of type, 
                frequency, extent site, and duration.
            ``(3) Restriction on certain changes.--A group health plan 
        or health insurance issuer may not, in order to comply with the 
        requirement of paragraph (1), make changes to benefits or 
        replace existing benefits with new benefits under the plan or 
        health insurance coverage designed to have the effect of--
                    ``(A) imposing an increase in out-of-pocket costs 
                with respect to anticancer medications;
                    ``(B) reclassifying benefits with respect to 
                anticancer medications in a way that would increase 
                such costs; or
                    ``(C) applying more restrictive limitations on 
                prescribed orally administered anticancer medications 
                than on intravenously administered or injected 
                anticancer medications.
            ``(4) Construction.--Nothing in this subsection shall be 
        construed--
                    ``(A) to require the use of orally administered 
                anticancer medications as a replacement for other 
                anticancer medications;
                    ``(B) to prohibit a group health plan or health 
                insurance issuer from requiring prior authorization or 
                imposing other appropriate utilization controls in 
                approving coverage for any chemotherapy; or
                    ``(C) to supersede a State law that provides 
                greater protections with respect to the coverage with 
                respect to orally administered anticancer medications 
                than is provided under this subsection.''.
            (2) Conforming amendment.--Section 2724(c) of the Public 
        Health Service Act (42 U.S.C. 300gg-23(c)) is amended by 
        striking ``section 2704'' and inserting ``sections 2719A, 2725, 
        and 2726''.
    (b) Clarifying Amendment Regarding Application to Grandfathered 
Plans.--Section 1251(a)(4)(A) of the Patient Protection and Affordable 
Care Act (42 U.S.C. 18011(a)(4)(A)) is amended by adding at the end the 
following new clause:
                            ``(v) Section 2719A(e).''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to group health plans for plan years beginning on or 
after January 1, 2016, and with respect to health insurance coverage 
offered, sold, issued, renewed, in effect, or operated in the 
individual or group market on or after such date.
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