Cancer Drug Parity Act of 2025
Summary
The Cancer Drug Parity Act of 2025 aims to amend the Employee Retirement Income Security Act of 1974 (ERISA) to ensure that cost-sharing for oral anticancer drugs is no less favorable than that for intravenously administered or injected anticancer medications. This bill seeks to eliminate disparities in insurance coverage for different forms of cancer medication. It mandates that group health plans provide equitable cost-sharing for patient-administered oral anticancer drugs, subject to medical necessity and clinical appropriateness, and includes a GAO study to assess the impact of the Act.
Expected Effects
If enacted, the Cancer Drug Parity Act of 2025 will require group health plans to provide cost-sharing for oral anticancer drugs on terms no less favorable than those for intravenously administered or injected anticancer medications. This change will likely reduce the financial burden on patients who rely on oral medications for cancer treatment. The GAO study will provide data on the Act's impact and inform future policy decisions.
Potential Benefits
- Reduced Financial Burden: Patients using oral anticancer drugs may experience lower out-of-pocket costs.
- Improved Access to Medication: More affordable oral medications could lead to better adherence and treatment outcomes.
- Equitable Coverage: Ensures fair treatment for different forms of cancer medication.
- Data-Driven Policy: The GAO study will provide valuable insights for future improvements.
- Prohibition of Benefit Changes: Prevents plans from shifting costs or restricting access to comply with the Act.
Potential Disadvantages
- Potential Premium Increases: Health plans may increase premiums to offset the cost of providing more equitable coverage.
- Administrative Burden: Plans may face increased administrative costs to implement and manage the new requirements.
- Limited Scope: The Act only applies to group health plans under ERISA, potentially excluding some individuals.
- Uncertainty of GAO Study Outcomes: The GAO study may reveal unintended consequences or areas needing further attention.
- Possible Utilization Controls: Health plans may implement stricter utilization controls, such as prior authorization, to manage costs.
Constitutional Alignment
This bill appears to align with the general welfare clause of the US Constitution, as it aims to improve access to healthcare and reduce financial burdens for individuals undergoing cancer treatment. Congress has the power to regulate interstate commerce, which includes regulating health insurance plans offered by employers. The bill does not appear to infringe on any specific constitutional rights or limitations.
Impact Assessment: Things You Care About ⓘ
This action has been evaluated across 19 key areas that matter to you. Scores range from 1 (highly disadvantageous) to 5 (highly beneficial).