Cancer Drug Parity Act of 2026

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[S. 5004 Introduced in Senate (IS)]

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119th CONGRESS
  2d Session
                                S. 5004

To amend the Employee Retirement Income Security Act of 1974 to require
a group health plan (or health insurance coverage offered in connection
with such a plan) to provide for cost-sharing for oral anticancer drugs
     on terms no less favorable than the cost-sharing provided for
     anticancer medications administered by a health care provider.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             July 15, 2026

 Ms. Smith (for herself and Mr. Moran) introduced the following bill;
     which was read twice and referred to the Committee on Health,
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL

To amend the Employee Retirement Income Security Act of 1974 to require
a group health plan (or health insurance coverage offered in connection
with such a plan) to provide for cost-sharing for oral anticancer drugs
     on terms no less favorable than the cost-sharing provided for
     anticancer medications administered by a health care provider.

    Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Cancer Drug Parity Act of 2026''.

SEC. 2. PARITY IN COST-SHARING FOR ORAL ANTICANCER DRUGS.

    (a) In General.--The Employee Retirement Income Security Act of
1974 is amended by inserting after section 726 of such Act (29 U.S.C.
1185o) the following new section:

``SEC. 727. PARITY IN COST-SHARING FOR ORAL ANTICANCER DRUGS.

    ``(a) In General.--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
are intravenously administered or injected by a health care provider.
    ``(b) Limitation.--Subsection (a) shall apply only to an anticancer
medication that is prescribed based on a finding by the treating
physician that the medication--
            ``(1) is medically necessary for the purpose of killing,
        slowing, or preventing the growth of cancerous cells; or
            ``(2) is clinically appropriate in terms of type,
        frequency, extent site, and duration.
    ``(c) Restriction on Certain Changes.--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--
            ``(1) imposing an increase in out-of-pocket costs with
        respect to anticancer medications;
            ``(2) reclassifying benefits with respect to anticancer
        medications in a way that would increase such costs; or
            ``(3) applying more restrictive limitations on prescribed
        orally administered anticancer medications than on
        intravenously administered or injected anticancer medications.
    ``(d) Construction.--Nothing in this section shall be construed--
            ``(1) to require the use of orally administered anticancer
        medications as a replacement for other anticancer medications;
            ``(2) 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 anticancer medication;
        or
            ``(3) 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.
    ``(e) Cost-Sharing Defined.--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, or similar out-of-pocket expense.''.
    (b) Technical Correction; Clerical Change.--The table of contents
in section 1 of the Employee Retirement Income Security Act of 1974 (29
U.S.C. 1001 note) is amended by inserting after the item relating to
section 726 the following new item:

``Sec. 727. Parity in cost-sharing for oral anticancer drugs.''.
    (c) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2027.

SEC. 3. GAO STUDY.

    Not later than 2 years after the date of enactment of this Act, the
Comptroller General of the United States shall--
            (1) complete a study that assesses the impact of section
        727 of the Employee Retirement Income Security Act of 1974, as
        added by section 2(a), on the out-of-pocket costs associated
        with oral and patient-administered anticancer medications
        furnished or dispensed to individuals enrolled in a group
        health plan to which such section 727 applies, in comparison to
        individuals enrolled in group health plans or health insurance
        coverage to which section 727 does not apply, including any
        recommendations or matters for congressional consideration
        regarding actions Federal agencies or Congress can take to
        reduce financial barriers to access to oral and patient-
        administered anticancer medications; and
            (2) submit to Congress a report on the results of such
        study, including recommendations or matters for congressional
        consideration to improve access to oral and patient-
        administered anticancer medications for individuals enrolled in
        group health plans and group or individual health insurance
        coverage offered by a health insurance issuer.
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