Sec. 2. Parity in cost-sharing for oral anticancer drugs
444 words·~2 min read·
/bill/118/s/2039/is/section-2A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
The Employee Retirement Income Security Act of 1974 is amended by inserting after section 725 of such Act ( 29 U.S.C. 1185d ) the following new section: Subject to subsection (b), a group health plan (or health insurance coverage offered in connection with such a plan) 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.
Subsection
(a)shall only apply to an anticancer medication that is prescribed based on a finding by the treating physician that the medication— is medically necessary for the purpose of killing, slowing, or preventing the growth of cancerous cells; or is clinically appropriate in terms of type, frequency, extent site, and duration. A group health plan (or health insurance coverage offered in connection with such a plan) may not, in order to comply with the requirement of subsection (a), make changes to benefits or replace existing benefits with new benefits under the plan (or health insurance coverage) designed to have the effect of— imposing an increase in out-of-pocket costs with respect to anticancer medications; reclassifying benefits with respect to anticancer medications in a way that would increase such costs; or applying more restrictive limitations on prescribed orally administered anticancer medications than on intravenously administered or injected anticancer medications. Nothing in this section shall be construed— to require the use of orally administered anticancer medications as a replacement for other anticancer medications; to prohibit a group health plan (or health insurance coverage offered in connection with such a plan) from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for any chemotherapy; or 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 section. In this section, 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. . The table of contents in section 1 of the Employee Retirement Income Security Act of 1974 ( 29 U.S.C. 1001 et seq. ) is amended by inserting after the item relating to section 725 the following new item: Sec. 726. Parity in cost-sharing for oral anticancer drugs. . The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2024.
Connectionstraces to 2
Traces to 2 documents
Citation graph
cites case law
Cites 2Cited by 0 across 0 sources