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Equal Costs for Cancer Drugs: Oral vs. Provider-Administered

New rules aim to ensure health insurance plans cover oral cancer medications with cost-sharing terms no less favorable than those for intravenously administered or injected cancer drugs. This means patients should not pay more for oral cancer drugs if they are medically necessary. The law is set to take effect for plan years beginning on or after January 1, 2022.
Key points
Health insurance plans must offer the same cost-sharing terms for oral cancer drugs as for those administered by a healthcare provider.
Plans are prohibited from increasing out-of-pocket costs or reclassifying benefits to circumvent these rules.
The act does not mandate replacing intravenous drugs with oral ones, nor does it prevent insurers from requiring prior authorization for chemotherapy.
These provisions apply to plan years starting on or after January 1, 2022.
A study will be conducted to assess the impact of these changes on patients' out-of-pocket costs.
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Additional Information
Print number: 117_HR_4385
Sponsor: Rep. Higgins, Brian [D-NY-26]
Process start date: 2021-07-09
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Summarized by: gemini-2.5-flash-preview-05-20
Source data: api.congress.gov
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OFFICIAL LEGAL TITLE

Cancer Drug Parity Act of 2021

FREQUENTLY ASKED QUESTIONS

What is the official ID of this bill?

The official print number for this legislation is 117_HR_4385.

Which chamber initiated this legislation?

This legislation was initiated in the House of Representatives.

When did the legislative process begin?

The process officially started on 2021-07-09.

What are the main provisions?

Key points include:

  • Health insurance plans must offer the same cost-sharing terms for oral cancer drugs as for those administered by a healthcare provider.
  • Plans are prohibited from increasing out-of-pocket costs or reclassifying benefits to circumvent these rules.
  • The act does not mandate replacing intravenous drugs with oral ones, nor does it prevent insurers from requiring prior authorization for chemotherapy.
  • These provisions apply to plan years starting on or after January 1, 2022.
  • A study will be conducted to assess the impact of these changes on patients' out-of-pocket costs.
What is the specific legal status?

The current status is Expired.

Where can I read the full text of this legislation?

The full official text is available at: View full text

Who is the primary sponsor?

The primary sponsor is Rep. Higgins, Brian [D-NY-26].

What is the latest detailed status?

The latest detailed status is: Referred to the House Committee on Education and Labor.

Is this summary verified?

Yes. This content was analyzed by AI and verified by the Lustra Judge System on 2025-12-28.

CATEGORIES

Health