Cancer Drug Parity Act of 2025
The Cancer Drug Parity Act of 2025 would extend ERISA rules to require group health plans and health insurance coverage connected to those plans to provide cost-sharing for FDA-approved, patient-administered oral anticancer drugs that is no less favorable than the cost-sharing for anticancer medications administered intravenously or by injection. The parity applies when a physician finds the oral drug medically necessary or clinically appropriate. The bill prohibits plan changes intended to raise out-of-pocket costs for oral anticancer meds or to apply more restrictive limits on oral therapies than on IV/injected therapies, and it clarifies that the parity does not force oral drugs to replace other treatments or override stronger state protections. The changes take effect for plan years beginning on or after January 1, 2026, and a GAO study must assess the impact within two years of enactment and report back with recommendations. In short, the bill aims to reduce financial barriers to oral cancer drugs by ensuring their cost-sharing is treated comparably to traditional intravenously administered cancer treatments, while preserving plan flexibility and respecting existing laws and protections.
Key Points
- 1Parity in cost-sharing: Group health plans must ensure patient cost-sharing for FDA-approved, patient-administered oral anticancer drugs is no less favorable than for IV/injected anticancer medications.
- 2Conditions for applicability: The parity applies when the treating physician determines the oral drug is medically necessary or clinically appropriate for cancer treatment.
- 3Protections against shifting costs: Plans may not use changes in benefits to increase out-of-pocket costs, reclassify benefits to raise costs, or impose tighter limits on orally administered anticancer meds compared to IV meds.
- 4Construction and limits: The bill does not require oral drugs to replace other therapies, does not bar prior authorization or other utilization controls, and does not supersede state laws offering greater protections.
- 5Effective date and study: Applies to plan years beginning on or after January 1, 2026. A GAO study within two years of enactment will assess financial impacts and offer recommendations to improve access.