What does Preamble of Cancer Drug Parity Act of 2025 do?

This bill amends the Employee Retirement Income Security Act of 1974. It requires group health plans to provide cost-sharing for oral anticancer drugs. The cost-sharing for oral anticancer drugs must be no less favorable than that provided for anticancer medications administered by a health care provider.

What does SHORT TITLE. of Cancer Drug Parity Act of 2025 do?

This bill is formally titled the Cancer Drug Parity Act of 2025.

What does PARITY IN COST-SHARING FOR ORAL ANTICANCER DRUGS. of Cancer Drug Parity Act of 2025 do?

This section amends the Employee Retirement Income Security Act of 1974 to establish parity in cost-sharing for oral and intravenously administered anticancer drugs. Group health plans and health insurance coverage must provide no less favorable cost-sharing for prescribed, patient-administered oral anticancer medications approved by the FDA compared to intravenously administered or injected medications. The requirement applies if a treating physician finds the medication is medically necessary or clinically appropriate. Plans are restricted from making changes to benefits that would increase out-of-pocket costs or impose more restrictive limitations on oral medications compared to intravenous ones. The section does not require the use of oral medications as replacements for other treatments and does not prohibit prior authorization or utilization controls. State laws providing greater protections for oral anticancer medication coverage supersede this federal provision.

What does GAO STUDY. of Cancer Drug Parity Act of 2025 do?

This section requires the Comptroller General of the United States to conduct a study on the impact of section 726 of the Employee Retirement Income Security Act of 1974. The study will assess the out-of-pocket costs associated with oral and patient-administered anticancer medications for individuals in group health plans subject to section 726 compared to those not subject to it. The Comptroller General must submit a report to Congress detailing the study's results and including recommendations for improving access to these medications. The report should include matters for congressional consideration regarding actions Federal agencies or Congress can take to reduce financial barriers.

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Cancer Drug Parity Act of 2025

Last updated: 6/24/2025 · Introduced: 6/24/2025

Author: Glenn Grothman (R-WI)

TL;DR (AI)

This bill requires group health plans to provide comparable cost-sharing for oral anticancer drugs as they do for intravenously administered anticancer drugs, provided a physician deems the oral medication medically necessary.
The bill prohibits health plans from increasing out-of-pocket costs or imposing more restrictive limitations on oral medications compared to intravenous ones.
The Government Accountability Office will conduct a study and report to Congress on the financial impact of current regulations on access to oral anticancer medications.

119th Congressin committeeOfficial page

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Other Sections

Includes provisions on preamble, short title., and 2 more.

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