This bill adds a new section to the Employee Retirement Income Security Act (ERISA). It requires group health plans (and insurance sold with those plans) that cover provider‑administered anticancer medications to offer cost‑sharing for prescribed, patient‑administered oral anticancer drugs on terms no less favorable than for anticancer drugs given intravenously or by injection. The rule applies only to oral anticancer drugs that are FDA‑approved and prescribed when the treating physician finds the drug is medically necessary or clinically appropriate. Plans may not respond by raising out‑of‑pocket costs, reclassifying benefits to increase costs, or applying stricter limits to oral drugs than to infused or injected drugs. Plans may still require prior authorization or other utilization controls. The bill defines cost‑sharing to include deductibles, coinsurance, copayments, and related out‑of‑pocket limits. The changes apply for plan years beginning on or after January 1, 2026. The Comptroller General must complete and report a study within two years after enactment on the law's impact on out‑of‑pocket costs and provide recommendations to improve access.
No publicly available information on estimated federal costs, changes to premiums, or specific cost impacts is included in the bill text or metadata. The bill does prohibit plans from making changes that would increase out‑of‑pocket costs to comply, and it requires a federal study on cost impacts and recommendations.
Supporters say the bill ensures parity in cost‑sharing so prescribed oral anticancer drugs are not treated less favorably than drugs given by a provider. The bill text is written to preserve physician decision‑making and allow standard utilization controls while preventing benefit changes that would raise patients' out‑of‑pocket costs.
No publicly available information on specific opposing views or official objections is included in the bill text or metadata.