Congress·In Committee·H.R. 4101

Rep. Grothman Introduces Cancer Drug Parity Act to Lower Costs for Oral Chemotherapy

Cancer Drug Parity Act of 2025

9 months ago·View on Congress.gov

Legislative Progress

House

Senate

President

Law

Key Points

This bill requires employer-sponsored health plans to charge the same out-of-pocket costs for oral cancer drugs (pills taken at home) as they do for IV or injected cancer treatments given by a doctor. Right now, many plans charge much higher copays for oral medications, making them unaffordable for some patients.
The bill only applies to oral cancer drugs that a doctor has determined are medically necessary or clinically appropriate for the patient. It doesn't force anyone to switch from IV treatments to pills.
Insurance companies can't game the system by raising costs on other cancer treatments or making it harder to access oral drugs just to get around the new rules. The bill specifically blocks those workarounds.
If enacted, the new cost-sharing rules would kick in for plan years starting on or after January 1, 2026. A GAO study would also be completed within two years to evaluate whether the law is actually reducing financial barriers for cancer patients.
From policy text
“The amendments made by this section shall apply with respect to plan years beginning on or after January 1, 2026.”
View in full text
The bill amends ERISA, which governs employer-sponsored health plans. It does not directly apply to individual marketplace plans or government programs like Medicare or Medicaid, though it preserves stronger state-level protections where they exist.

Healthcare

Impact Analysis

Personal Impact

Who is affectedScoreImpactCertaintyScopeDurationSentiment

Scores: 1 = low, 5 = highSentiment: -5 to +5 (net benefit)

Milestones

2 milestones2 actions

Jun 24, 2025House

Referred to the House Committee on Education and Workforce.

Jun 24, 2025

Introduced in House

What Happens Next

Projected impacts based on AI analysis

2026-01-01

New cost-sharing parity rules take effect for employer health plans

Cancer patients on employer-sponsored insurance would start seeing equal copays for oral and IV cancer drugs when their plan year begins on or after this date.

Within 2 years of enactment

GAO completes study on the law's impact on out-of-pocket costs

Congress would get a report showing whether the law actually saved cancer patients money, along with recommendations for further action to reduce financial barriers to treatment.

Related News

3 articles

WisBusiness·9 months ago

THU AM News: Rockwell Automation report sheds light on life sciences manufacturing trends; Marquette Law School Poll finds greater concern about PFAS in water supply

The Cancer Drug Parity Act would require health insurers to cover oral cancer treatments 'on the same level' as traditional intravenous therapies. It expands protections to patients with private insurance whose health care is regulated at the federal level, addressing high out-of-pocket costs.

News-Medical.Net·11 months ago

New Medicare changes ease cost burden for cancer drugs

While discussing the Inflation Reduction Act's $2,000 cap on Medicare drug costs, the report notes that the Cancer Drug Parity Act remains a critical legislative goal to equalize costs for oral and IV treatments for those in private plans not covered by the new Medicare caps.

C+

ASH Clinical News·about 4 years ago

The Pharmacoeconomics of Oral and Self-Administered Cancer Treatments

This analysis explores the 'oral parity' issue, noting that oral drugs are often covered under pharmacy benefits with high coinsurance, while IV drugs fall under medical benefits. It highlights the Cancer Drug Parity Act as the primary federal solution to this cost discrepancy.