[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1730 Introduced in House (IH)]
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116th CONGRESS
1st Session
H. R. 1730
To amend the Public Health Service Act to require group and individual
health insurance coverage and group health plans 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.
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IN THE HOUSE OF REPRESENTATIVES
March 13, 2019
Mr. Higgins of New York (for himself, Mr. Guthrie, Ms. Matsui, Mr.
Bilirakis, Mr. Kilmer, Mr. Fitzpatrick, Mr. King of New York, Mr.
Nadler, Mr. DeFazio, Mr. Hastings, Mr. Olson, Ms. Wasserman Schultz,
Mr. Hurd of Texas, Mr. Bera, Mr. Cole, Mr. Khanna, Mr. McCaul, and Ms.
Norton) introduced the following bill; which was referred to the
Committee on Energy and Commerce
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to require group and individual
health insurance coverage and group health plans 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.
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 Parity Act of 2019''.
SEC. 2. PARITY IN COST SHARING 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 Cost Sharing 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 that any cost sharing 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 is no less favorable than the cost sharing for
anticancer medications that is intravenously administered or
injected by a health care provider.
``(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.
``(5) Cost sharing defined.--In this subsection, the term
`cost sharing' includes a deductible, coinsurance, copayment,
and any maximum limitation on the application of such a
deductible, coinsurance, copayment, and similar out-of-pocket
expenses.''.
(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) (relating to cost
sharing for oral anticancer drugs).''.
(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, 2020, 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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