H.R. 4101 — Cancer Drug Parity Act of 2025

This section establishes parity requirements for cost-sharing of prescribed, patient-administered (oral) anticancer medications—defined as FDA-approved drugs used to kill, slow, or prevent the growth of cancerous cells—in group health plans (and health insurance coverage offered in connection with such plans) that cover provider-administered (intravenously administered or injected) anticancer medications. Cost-sharing (i.e., deductibles, coinsurance, copayments, and out-of-pocket maximums) for such oral medications must be no less favorable than for provider-administered medications when prescribed as medically necessary or clinically appropriate; prohibits plans from circumventing this requirement by increasing out-of-pocket costs, reclassifying benefits, or imposing stricter limits on oral medications; and clarifies that the provision does not require replacing other anticancer medications with oral ones, permits prior authorization or utilization controls, and defers to stronger state laws. The requirements apply to plan years beginning on or after January 1, 2026. (Thus, plans covering infused chemotherapy must align copays and other cost-sharing for equivalent oral chemotherapy drugs.)

This section directs the Comptroller General of the United States to complete, not later than two years after enactment, a study assessing the impact of new ERISA section 726—which limits out-of-pocket costs for oral and patient-administered anticancer medications in certain group health plans—on such costs for enrollees in plans subject to the section, compared to those in plans not subject to it. The section further requires submission to Congress of a report on the study results, including recommendations for federal agencies or Congress to reduce financial barriers and improve access to those medications in group health plans and group or individual health insurance coverage.