Bill > HR4101

This bill, known as the Cancer Drug Parity Act of 2025, aims to ensure that group health plans provide equal cost-sharing for oral anticancer medications compared to intravenous or injected anticancer treatments administered by healthcare providers. Specifically, the bill requires that patients pay the same out-of-pocket costs for oral cancer drugs as they would for medications given directly by a healthcare provider. The bill applies only to FDA-approved medications prescribed by a treating physician as medically necessary and clinically appropriate. Health plans are prohibited from increasing out-of-pocket costs, reclassifying benefits, or imposing more restrictive limitations on oral medications as a way to comply with the new requirement. The bill does not mandate the use of oral medications over other treatments and allows health plans to still require prior authorization and utilization controls. Additionally, the bill requires the Government Accountability Office (GAO) to conduct a study within two years of enactment to assess the impact of these cost-sharing provisions on patients' access to oral cancer medications, with a report to be submitted to Congress including potential recommendations for further improving medication access.

Education

https://www.congress.gov/bill/119th-congress/house-bill/4101/all-info