Parity in cost-sharing for oral anticancer drugs

(a) In general The Employee Retirement Income Security Act of 1974 is amended by inserting after section 726 of such Act (29 U.S.C. 1185o) the following new section: 727. Parity in cost-sharing for oral anticancer drugs (a) In general Subject to subsection (b), a group health plan (or health insurance coverage offered in connection with such a plan) 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 are intravenously administered or injected by a health care provider. (b) Limitation Subsection (a) shall apply only to an anticancer medication that is prescribed based on a finding by the treating physician that the medication— (1) is medically necessary for the purpose of killing, slowing, or preventing the growth of cancerous cells; or (2) is clinically appropriate in terms of type, frequency, extent site, and duration. (c) Restriction on certain changes A group health plan (or health insurance coverage offered in connection with such a plan) may not, in order to comply with the requirement of subsection (a), make changes to benefits or replace existing benefits with new benefits under the plan (or health insurance coverage) designed to have the effect of— (1) imposing an increase in out-of-pocket costs with respect to anticancer medications; (2) reclassifying benefits with respect to anticancer medications in a way that would increase such costs; or (3) applying more restrictive limitations on prescribed orally administered anticancer medications than on intravenously administered or injected anticancer medications. (d) Construction Nothing in this section shall be construed— (1) to require the use of orally administered anticancer medications as a replacement for other anticancer medications; (2) to prohibit a group health plan (or health insurance coverage offered in connection with such a plan) from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for any anticancer medication; or (3) 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 section. (e) Cost-Sharing defined In this section, the term cost-sharing includes a deductible, coinsurance, copayment, and any maximum limitation on the application of such a deductible, coinsurance, copayment, or similar out-of-pocket expense.. (b) Technical Correction; Clerical Change The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 (29 U.S.C. 1001 note) is amended by inserting after the item relating to section 726 the following new item: Sec. 727. Parity in cost-sharing for oral anticancer drugs.. (c) Effective date The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2027.