This bill amends the Employee Retirement Income Security Act of 1974 (ERISA) to ensure equitable cost-sharing for cancer treatments. It mandates that group health plans and associated health insurance coverage provide cost-sharing for prescribed, patient-administered oral anticancer medications on terms no less favorable than those applied to anticancer medications administered intravenously or by injection by a healthcare provider, provided the oral drug is medically necessary or clinically appropriate. To prevent circumvention, the bill explicitly prohibits plans from increasing out-of-pocket costs, reclassifying benefits to raise costs, or imposing more restrictive limitations on oral anticancer medications compared to administered ones. The legislation clarifies that it does not require the use of oral medications as a replacement for other treatments, nor does it prohibit plans from requiring prior authorization or other appropriate utilization controls. It also ensures that stronger state laws offering greater protections for orally administered anticancer medications are not superseded, and defines "cost-sharing" broadly to include deductibles, coinsurance, copayments, and any maximum out-of-pocket limitations. Finally, the Act includes a provision for a Government Accountability Office (GAO) study to be completed within two years of enactment, assessing the impact on out-of-pocket costs and providing recommendations to Congress.
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Cancer Drug Parity Act of 2026
USA119th CongressS-5004| Senate
| Updated: 7/15/2026
This bill amends the Employee Retirement Income Security Act of 1974 (ERISA) to ensure equitable cost-sharing for cancer treatments. It mandates that group health plans and associated health insurance coverage provide cost-sharing for prescribed, patient-administered oral anticancer medications on terms no less favorable than those applied to anticancer medications administered intravenously or by injection by a healthcare provider, provided the oral drug is medically necessary or clinically appropriate. To prevent circumvention, the bill explicitly prohibits plans from increasing out-of-pocket costs, reclassifying benefits to raise costs, or imposing more restrictive limitations on oral anticancer medications compared to administered ones. The legislation clarifies that it does not require the use of oral medications as a replacement for other treatments, nor does it prohibit plans from requiring prior authorization or other appropriate utilization controls. It also ensures that stronger state laws offering greater protections for orally administered anticancer medications are not superseded, and defines "cost-sharing" broadly to include deductibles, coinsurance, copayments, and any maximum out-of-pocket limitations. Finally, the Act includes a provision for a Government Accountability Office (GAO) study to be completed within two years of enactment, assessing the impact on out-of-pocket costs and providing recommendations to Congress.