S 741 — Cancer Drug Parity Act of 2019

Summary

Cancer Drug Parity Act of 2019 This bill requires health plans that cover anticancer medications administered by a health care provider to provide no less favorable cost sharing for patient-administered anticancer medications. This requirement applies to medications that are (1) approved by the Food and Drug Administration; (2) medically necessary for the cancer treatment; and (3) clinically appropriate in terms of type, frequency, extent site, and duration.To comply with this requirement, health plans may not, with respect to 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.

Bill Text

• Introduced Introduced in Senate Current html March 12, 2019

Compared against current U.S. Code AI-generated reading aid — verify against the official bill.

The bill adds requirements for cost sharing related to oral anticancer drugs in health insurance coverage and modifies existing law to incorporate these requirements.

• 42 U.S.C. 300gg-19a

  (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.

  This addition requires parity in cost sharing for oral anticancer drugs compared to injected or intravenously administered anticancer medications.

• 42 U.S.C. 300gg-19a

  (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.

  This limits the requirement for cost sharing parity to medications deemed medically necessary or clinically appropriate.

• 42 U.S.C. 300gg-19a

  (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.

  This prevents insurance plans from increasing costs or imposing stricter limits on oral anticancer drugs in response to the new parity requirement.

• 42 U.S.C. 300gg-19a

  (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.

  This clarifies that the new law does not mandate replacement of other treatments and allows for prior authorization while safeguarding state laws that offer more protections.

• 42 U.S.C. 300gg-19a

  (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.

  This provides a definition for 'cost sharing' to clarify what is included under the new requirements.

• 42 U.S.C. 18011(a)(4)(A)

  striking "section 2704" → inserting "sections 2719A, 2725, and 2726"

  This amendment extends the application of grandfathered plan provisions to include the new requirements for cost sharing for oral anticancer drugs.

Action History

1. March 12, 2019

   Introduced in Senate

2. March 12, 2019

   Read twice and referred to the Committee on Health, Education, Labor, and Pensions.

Sponsors

• Tina Smith · Primary
• Jerry Moran · Cosponsor
• Christopher Murphy · Cosponsor
• Roger F. Wicker · Cosponsor
• Sherrod Brown · Cosponsor
• Lisa Murkowski · Cosponsor
• Amy Klobuchar · Cosponsor
• Cindy Hyde-Smith · Cosponsor
• John Boozman · Cosponsor
• Edward J. Markey · Cosponsor
• Richard Blumenthal · Cosponsor
• Susan M. Collins · Cosponsor
• Tammy Baldwin · Cosponsor
• Kevin Cramer · Cosponsor
• Jeff Merkley · Cosponsor
• Marsha Blackburn · Cosponsor
• Sheldon Whitehouse · Cosponsor
• Shelley Moore Capito · Cosponsor
• Doug Jones · Cosponsor
• Rick Scott · Cosponsor

Subjects