Cancer Drug Parity Act of 2025
- Bill Number
- H.R. 4101
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Health
- Status
- Introduced
- Latest Action
- 2025-06-24: Referred to the House Committee on Education and Workforce.
- Last Updated
- 2026-03-17T08:05:49Z
AI-Generated Summary
Cancer Drug Parity Act of 2025 (H.R. 4101)
Purpose
This legislation amends the Employee Retirement Income Security Act of 1974 (ERISA) to require group health plans (and related health insurance coverage) to apply cost-sharing terms for oral anticancer drugs that are no less favorable than those for anticancer medications administered intravenously or by injection by a health care provider.
Key Provisions
- Parity Requirement: Plans must ensure cost-sharing (including deductibles, coinsurance, copayments, and out-of-pocket limits) for FDA-approved, patient-administered oral anticancer drugs used to kill, slow, or prevent cancerous cell growth matches the terms for provider-administered versions.
- Eligibility Limits: Applies only when the treating physician determines the medication is medically necessary for killing, slowing, or preventing cancerous cell growth or is clinically appropriate in type, frequency, extent, site, and duration.
- Benefit Change Restrictions: Plans may not increase out-of-pocket costs, reclassify benefits, or apply more restrictive limits on oral drugs to achieve compliance.
- Protections and Limits: Does not require use of oral drugs over other options, allows prior authorization and utilization controls, and does not override stronger state laws on oral anticancer medication coverage.
- Definition: Cost-sharing explicitly includes deductibles, coinsurance, copayments, and related out-of-pocket expenses.
- GAO Study: Requires the Comptroller General to assess impacts on out-of-pocket costs for oral anticancer drugs within two years and report to Congress with recommendations on reducing financial barriers.
- Effective Date: Applies to plan years beginning on or after January 1, 2026.
Significant Changes to Existing Law
The bill adds a new Section 726 to ERISA, creating a federal parity standard for anticancer drug cost-sharing in covered group health plans where none previously existed under federal law. It updates the ERISA table of contents accordingly.
Potential Impacts
- On Citizens: May lower out-of-pocket expenses for patients prescribed oral anticancer medications in affected plans, improving access and reducing financial barriers compared to provider-administered alternatives.
- On Government Agencies: Mandates a GAO study and report to Congress; no direct new responsibilities for other agencies.
- On International Relations: No provisions or impacts identified.
Main Stakeholders Affected
- Individuals enrolled in ERISA-regulated group health plans who use oral anticancer drugs.
- Employers sponsoring group health plans and health insurance issuers offering coverage in connection with such plans.
- Treating physicians prescribing anticancer medications.
- The Comptroller General of the United States (for the required study).
Notable Legal, Constitutional, or Political Implications
- Legal: Establishes a targeted federal floor for cost-sharing parity limited to ERISA plans; explicitly preserves stronger state laws and allows utilization management tools.
- Constitutional: No direct implications noted in the legislation.
- Political: Introduced with bipartisan sponsorship; focuses on reducing disparities in cancer treatment costs without mandating specific drug use or overriding existing plan flexibility.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Cosponsors (27)
Rep. Bonamici, Suzanne [D-OR-1], Rep. Bilirakis, Gus M. [R-FL-12], Rep. Fitzpatrick, Brian K. [R-PA-1], Rep. Morelle, Joseph D. [D-NY-25], Rep. Matsui, Doris O. [D-CA-7], Rep. Brownley, Julia [D-CA-26], Rep. Moore, Gwen [D-WI-4], Rep. Davis, Donald G. [D-NC-1], Rep. Davids, Sharice [D-KS-3], Rep. Wilson, Joe [R-SC-2], Rep. Kennedy, Timothy M. [D-NY-26], Rep. Castor, Kathy [D-FL-14], Rep. Raskin, Jamie [D-MD-8], Del. Norton, Eleanor Holmes [D-DC-At Large], Rep. Balint, Becca [D-VT-At Large], Rep. Bresnahan, Robert P. [R-PA-8], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Ross, Deborah K. [D-NC-2], Rep. Garamendi, John [D-CA-8], Rep. Houlahan, Chrissy [D-PA-6], Rep. Jackson, Jonathan L. [D-IL-1], Rep. Conaway, Herbert C. [D-NJ-3], Rep. Salinas, Andrea [D-OR-6], Rep. Bynum, Janelle S. [D-OR-5], Rep. Neguse, Joe [D-CO-2], Rep. Pappas, Chris [D-NH-1], Rep. Schmidt, Derek [R-KS-2]
Recent Actions
- 2025-06-24: Referred to the House Committee on Education and Workforce.
- 2025-06-24: Introduced in House
- 2025-06-24: Introduced in House
Bill Versions
- Cancer Drug Parity Act of 2025 — issued 2025-06-24 — PDF (5 pages)