,i  #aacth ,,congress  #ast ,session    
,h4 ,r4 #ahja  ,,in ,,the ,,house ,,of  
,,representatives  ,april #bf1 #bjac    
,mr4 ,higgins 7for himself1 ,ms4 ,moore1
 ,ms4 ,pingree of ,maine1 ,mr4          
,cicilline1 ,mrs4 ,capps1 ,mr4          
,grijalva1 ,ms4 ,wilson of ,florida1    
,mr4 ,hastings of ,florida1 ,mr4 ,king  
of ,new ,york1 ,mr4 ,rangel1 ,mr4       
,larsen of ,washington1 ,mr4 ,mc,govern1
 ,mr4 ,peters of ,california1 ,mr4      
,wolf1 ,mr4 ,moran1 and ,mr4 ,farr7     
introduced the following bill2 which was
 referred to the ,committee on ,energy  
and ,commerce1 and in addition to the   
,committees on ,ways and ,means and     
,education and the ,workforce1 for a    
period to be subsequently determined by 
the ,speaker1 in each case for          
consideration of such provisions as fall
 within the jurisdiction of the         
committee concerned  ,a ,,bill  ,to     
amend the ,employee ,retirement ,income 
,security ,act of #aigd1 the ,public    
,health ,service ,act1 and the ,internal

 ,revenue ,code of #aihf 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 provider4  #a4 ,short title ,this  
,act may be cited as the ,cancer ,drug  
,coverage ,parity ,act of #bjac4  #b4   
,parity in coverage for oral anticancer 
drugs  7a7 ,employee ,retirement ,income
 ,security ,act of #aigd amendments     
7#a7 ,subpart ,b of part #g of subtitle 
,b of title ,i of the ,employee         
,retirement ,income ,security ,act of   
#aigd is amended by adding at the end   
the following new section3  #gaf4       
,parity in coverage for oral anticancer 
drugs  7a7 ,in general ,subject to      
subsection 7b71 a group health plan1 and
 a health insurance issuer providing    
health insurance coverage in connection 
with a group health plan1 that provides 
benefits with respect to anticancer     

medications administered by a health    
care provider shall provide for no less 
favorable coverage for prescribed1      
patient-administered anticancer         
medications that are used to kill1 slow1
 or prevent the growth of cancerous     
cells and that have been approved by the
 ,food and ,drug ,administration4  7b7  
,limitation ,subsection 7a7 shall only  
apply to an anticancer medication that  
is prescribed based on a finding by the 
treating physician that the medication--
  7#a7 is medically necessary for the   
purpose of killing1 slowing1 or         
preventing the growth of cancerous      
cells2 or  7#b7 is clinically           
appropriate in terms of type1 frequency1
 extent site1 and duration4  7c7        
,application of cost-,sharing and       
restrictions  7#a7 ,in general ,the     
coverage of anticancer medication under 
subsection 7a7 may be subject to annual 
deductibles and coinsurance or          
copayments so long as such deductibles1 
coinsurance1 and copayments do not      

exceed the deductibles1 coinsurance1 and
 copayments that are applicable to      
anticancer medications administered by a
 health care provider under the plan or 
coverage for the same purpose4  7#b7    
,restriction ,a group health plan or    
health insurance issuer may not1 in     
order to comply with the requirement of 
subsection 7a7--  7,a7 impose an        
increase in out-of-pocket costs with    
respect to anticancer medications2  7,b7
 reclassify benefits with respect to    
anticancer medications2 or  7,c7 apply  
more restrictive limitations on         
prescribed orally-administered          
anticancer medications or intravenously 
administered or injected anticancer     
medications4  7d7 ,application of       
notice1 prohibitions1 etc ,the          
provisions of subsections 7b71 7c71 7d71
 and 7e77#b7 of section #gac shall apply
 with respect to the coverage required  
by subsection 7a7 in the same manner as 
they apply with respect to the coverage 
required under such section1 except that

 ,january #a1 #bjad1 shall be           
substituted for the date referred to in 
subsection 7b77#c7 of such section4  7e7
 ,construction ,nothing in this section 
shall be construed--  7#a7 to require   
the use of orally-administered          
anticancer medications as a replacement 
for other anticancer medications2 or    
7#b7 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 chemotherapy4
  4  7#b7 ,section #gca7;c7 of such ,act
 7#bi ,u4,s4,c4 #aaia7;c77 is amended by
 striking section #gaa and inserting    
sections #gaa and #gaf4  7#c7 ,section  
#gcb7;a7 of such ,act 7#bi ,u4,s4,c4    
#aaia;a7a77 is amended by striking      
section #gaa and inserting sections #gaa
 and #gaf4  7#d7 ,the table of contents 
in section #a of such ,act is amended by
 inserting after the item relating to   
section #gad the following new items3   
,sec4 #gae4 ,additional market reforms4 

,sec4 #gaf4 ,parity in coverage for oral
 anticancer drugs4  4  7b7 ,public      
health service act amendments  7#a7     
,title ,,xxvii of the ,public ,health   
,service ,act is amended by inserting   
after section #bgbh 7#db ,u4,s4,c4      
#cjj;gg-#bh71 as redesignated by section
 #ajja7b7 of the ,patient ,protection   
and ,affordable ,care ,act 7,public ,law
 #aaa-adh71 the following new section3  
#bgbi4 ,parity in coverage for oral     
anticancer drugs  7a7 ,in general       
,subject to subsection 7b71 a group     
health plan1 and a health insurance     
issuer offering health insurance        
coverage1 that provides benefits with   
respect to anticancer medications       
administered by a health care provider  
shall provide for no less favorable     
coverage for prescribed1                
patient-administered anticancer         
medications that are used to kill1 slow1
 or prevent the growth of cancerous     
cells and that have been approved by the
 ,food and ,drug ,administration4  7b7  

,limitation ,subsection 7a7 shall only  
apply to an anticancer medication that  
is prescribed based on a finding by the 
treating physician that the medication--
  7#a7 is medically necessary for the   
purpose of killing1 slowing1 or         
preventing the growth of cancerous      
cells2 or  7#b7 is clinically           
appropriate in terms of type1 frequency1
 extent site1 and duration4  7c7        
,application of cost-,sharing and       
restrictions  7#a7 ,in general ,the     
coverage of anticancer medication under 
subsection 7a7 may be subject to annual 
deductibles and coinsurance or          
copayments so long as such deductibles1 
coinsurance1 and copayments do not      
exceed the deductibles1 coinsurance1 and
 copayments that are applicable to      
anticancer medications administered by a
 health care provider under the plan or 
coverage for the same purpose4  7#b7    
,restriction ,a group health plan or    
health insurance issuer may not1 in     
order to comply with the requirement of 

subsection 7a7--  7,a7 impose an        
increase in out-of-pocket costs with    
respect to anticancer medications2  7,b7
 reclassify benefits with respect to    
anticancer medications2 or  7,c7 apply  
more restrictive limitations on         
prescribed orally-administered          
anticancer medications or intravenously 
administered or injected anticancer     
medications4  7d7 ,application of       
notice1 prohibitions1 etc ,the          
provisions of subsections 7b71 7c71 7d71
 and 7e77#b7 of section #gac of the     
,employee ,retirement and ,income       
,security ,act of #aigd shall apply with
 respect to the coverage required by    
subsection 7a7 in the same manner as    
they apply with respect to the coverage 
required under such section1 except that
 ,january #a1 #bjad1 shall be           
substituted for the date referred to in 
subsection 7b77#c7 of such section4  7e7
 ,construction ,nothing in this section 
shall be construed--  7#a7 to require   
the use of orally-administered          

anticancer medications as a replacement 
for other anticancer medications2 or    
7#b7 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 chemotherapy4
  4  7#b7 ,section #bgbd7;c7 of such    
,act 7#db ,u4,s4,c4 #cjj;gg-#bc7;c771 as
 redesignated by section #ajja7d7 and   
subsection 7c77#ad7 of the section #aefc
 7relating to conforming amendments7 of 
,public ,law #aaa-adh1 is amended by    
striking section #bgjd and inserting    
sections #bgbe and #bgbi4  7#c7 ,section
 #bgfb7;b77#b7 of such ,act 7#db        
,u4,s4,c4 #cjj;gg-#fb7;b77#b77 is       
amended by striking section #bgea and   
inserting sections #bgea and #bgbi4     
7#d7 ,for purposes of applying section  
#bgbi of the ,public ,health ,service   
,act1 as inserted by paragraph 7#a71 to 
individual health insurance coverage    
before #bjad1 the provisions of such    
section shall be treated as also        

included under part ,b of title ,,xxvii 
of the ,public ,health ,service ,act4   
7c7 ,internal revenue code amendments   
7#a7 ,in general ,subchapter ,b of      
chapter #ajj of the ,internal ,revenue  
,code of #aihf1 as amended by subsection
 7f7 of the section #aefc 7relating to  
conforming amendments7 of ,public ,law  
#aaa-adh1 is amended by adding at the   
end the following new section3  #ihaf4  
,parity in coverage for oral anticancer 
drugs  7a7 ,in general ,subject to      
subsection 7b71 a group health plan that
 provides benefits with respect to      
anticancer medications administered by a
 health care provider shall provide for 
no less favorable coverage for          
prescribed1 patient-administered        
anticancer medications that are used to 
kill1 slow1 or prevent the growth of    
cancerous cells and that have been      
approved by the ,food and ,drug         
,administration4  7b7 ,limitation       
,subsection 7a7 shall only apply to an  
anticancer medication that is prescribed

 based on a finding by the treating     
physician that the medication--  7#a7 is
 medically necessary for the purpose of 
killing1 slowing1 or preventing the     
growth of cancerous cells2 or  7#b7 is  
clinically appropriate in terms of type1
 frequency1 extent site1 and duration4  
7c7 ,application of cost-,sharing and   
restrictions  7#a7 ,in general ,the     
coverage of anticancer medication under 
subsection 7a7 may be subject to annual 
deductibles and coinsurance or          
copayments so long as such deductibles1 
coinsurance1 and copayments do not      
exceed the deductibles1 coinsurance1 and
 copayments that are applicable to      
anticancer medications administered by a
 health care provider under the plan for
 the same purpose4  7#b7 ,restriction ,a
 group health plan may not1 in order to 
comply with the requirement of          
subsection 7a7--  7,a7 impose an        
increase in out-of-pocket costs with    
respect to anticancer medications2  7,b7
 reclassify benefits with respect to    

anticancer medications2 or  7,c7 apply  
more restrictive limitations on         
prescribed orally-administered          
anticancer medications or intravenously 
administered or injected anticancer     
medications4  7d7 ,application of       
notice1 prohibitions1 etc ,the          
provisions of subsections 7b71 7c71 7d71
 and 7e77#b7 of section #gac of the     
,employee ,retirement and ,income       
,security ,act of #aigd shall apply with
 respect to the coverage required by    
subsection 7a7 in the same manner as    
they apply with respect to the coverage 
required under such section1 except that
 ,january #a1 #bjad1 shall be           
substituted for the date referred to in 
subsection 7b77#c7 of such section4  7e7
 ,construction ,nothing in this section 
shall be construed--  7#a7 to require   
the use of orally-administered          
anticancer medications as a replacement 
for other anticancer medications2 or    
7#b7 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 chemotherapy4
  4  7#b7 ,clerical amendment ,the table
 of sections for such subchapter is     
amended by adding at the end the        
following new items3  ,sec4 #ihae4      
,additional market reforms4 ,sec4 #ihaf4
 ,parity in coverage for oral anticancer
 drugs4  4  7d7 ,clarifying amendment   
regarding application to grandfathered  
plans ,section #abea7;a77#d77;,a7 of the
 ,patient ,protection and ,affordable   
,care ,act 7,public ,law #aaa-adh2 #db  
,u4,s4,c4 #ahjaa7;a77#d77;,a771 as added
 by section #bcja7;a7 of ,public ,law   
#aaa-aeb1 is amended by adding at the   
end the following new clause3  7v7      
,section #bgbi1 as added by section     
#b7;b7 of the ,cancer ,drug ,coverage   
,parity ,act of #bjac4  4  7e7          
,effective date ,the amendments made by 
this section shall apply with respect to
 group health plans for plan years      
beginning on or after ,january #a1      

#bjad1 and with respect to health       
insurance coverage offered1 sold1       
issued1 renewed1 in effect1 or operated 
in the individual market on or after    
such date4  7f7 ,study ,not later than  
#b years after the date of the enactment
 of this ,act--  7#a7 the ,medicare     
,payment ,advisory ,commission shall    
complete a study that assesses how      
closing the ,medicare part ,d donut hole
 under the amendments made by section   
#ccja of the ,patient ,protection and   
,affordable ,care ,act 7,public ,law    
#aaa-adh71 as amended by section #aaja  
of the ,health ,care and ,education     
,reconciliation ,act of #bjaj 7,public  
,law #aaa-aeb71 affects ,medicare       
coverage for orally administered        
anticancer medications1 with a          
particular focus on cost and            
accessibility2 and  7#b7 submit a report
 to ,congress on the results of such    
study4