# Cancer Drug Parity Act of 2021

Right now, many health insurance plans treat cancer drugs differently depending on how they're delivered to your body. If you get chemotherapy through an IV or injection at a hospital or doctor's office, your insurance covers it one way. But if your doctor prescribes a pill or tablet form of cancer medication that you take at home, your insurance might charge you much more out of pocket. This bill aims to fix that unfair situation by requiring insurance plans to treat oral cancer drugs the same way they treat injected or IV cancer drugs.

Here's what that means in practical terms: If your insurance plan charges you a $50 copay for an IV chemotherapy treatment, they'd have to charge you the same $50 copay for an equivalent oral cancer medication instead of potentially charging you hundreds of dollars more. The same goes for deductibles and coinsurance—the percentage of costs you pay after meeting your deductible. Insurance companies also can't get around this rule by suddenly making oral cancer drugs harder to access through extra approval requirements or by moving them to a more expensive category of coverage. The bill applies to employer-sponsored health plans, which cover millions of Americans.

There are a few important limits to understand. The rule only applies when a doctor determines the oral medication is medically necessary or clinically appropriate for treating cancer. Insurance companies can still require prior authorization—basically asking the doctor to justify why the drug is needed—just like they do for other chemotherapy. Additionally, if your state already has laws protecting oral cancer drug coverage even more than this federal bill does, those state protections remain in place. The bill takes effect for insurance plans starting in 2022, and Congress requested a study to see how well it's working and whether more needs to be done to help cancer patients afford their medications.

Cancer Drug Parity Act of 2021

Higgins, Brian

Cancer Drug Parity Act of 2021 This bill requires group health plans that cover anticancer medications administered by a health care provider to provide no less favorable cost sharing for patient-administered anticancer medications. This requirement applies to medications that are (1) approved by the Food and Drug Administration; (2) medically necessary for the cancer treatment; and (3) clinically appropriate in terms of type, frequency, extent site, and duration. To comply with this requirement, plans may not,&nbsp;with respect to&nbsp;anticancer medications (1) change or replace benefits to increase out-of-pocket costs, (2) reclassify benefits to increase costs, or (3) apply more restrictive limitations to orally administered medications than to intravenously administered or injected medications.