text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Cancer Drug Coverage Parity Act of 
  2011''.
  
  SEC. 2. PARITY IN COVERAGE FOR ORAL ANTICANCER DRUGS.
  
      (a) Employee Retirement Income Security Act of 1974 Amendments.--
  (1) Subpart B of part 7 of subtitle B of title I of the Employee 
  Retirement Income Security Act of 1974 is amended by adding at the end 
  the following new section:
  
  ``SEC. 716. PARITY IN COVERAGE FOR ORAL ANTICANCER DRUGS.
  
      ``(a) In General.--Subject to subsection (b), a group health plan, 
  and a health insurance issuer providing health insurance coverage in 
  connection with a group health plan, that provides benefits with 
  respect to intravenously administered or injected anticancer 
  medications shall provide for no less favorable coverage for 
  prescribed, orally administered anticancer medication that is used to 
  kill or slow the growth of cancerous cells and that has been approved 
  by the Food and Drug Administration.
      ``(b) Limitation.--Subsection (a) shall only apply to anticancer 
  medication that is prescribed based on a finding by the treating 
  physician that the medication--
              ``(1) is medically necessary for the purpose of killing or 
          slowing the growth of cancerous cells in a manner that is in 
          accordance with nationally accepted standards of medical 
          practice;
              ``(2) is clinically appropriate in terms of type, 
          frequency, extent site, and duration; and
              ``(3) is not primarily for the convenience of the patient, 
          physician, or other health care provider.
      ``(c) Application of Cost-Sharing and Restrictions.--
              ``(1) In general.--The coverage of anticancer medication 
          under subsection (a) may be subject to annual deductibles and 
          coinsurance or copayments so long as such deductibles, 
          coinsurance, and copayments do not exceed the deductibles, 
          coinsurance, and copayments that are applicable to 
          intravenously administered or injected anticancer medications 
          under the plan or coverage for the same purpose.
              ``(2) Restriction.--A group health plan or health insurance 
          issuer may not, in order to comply with the requirement of 
          subsection (a)--
                      ``(A) impose an increase in out-of-pocket costs 
                  with respect to anticancer medications; or
                      ``(B) reclassify benefits with respect to 
                  anticancer medications.
      ``(d) Application of Notice, Prohibitions, Etc.--The provisions of 
  subsections (b), (c), (d), and (e)(2) of section 713 shall apply with 
  respect to the coverage required by subsection (a) in the same manner 
  as they apply with respect to the coverage required under such section, 
  except that January 1, 2012, shall be substituted for the date referred 
  to in subsection (b)(3) of such section.
      ``(e) Construction.--Nothing in this section shall be construed--
              ``(1) to require the use of orally administered anticancer 
          medications as a replacement for other anticancer medications; 
          or
              ``(2) to prohibit a group health plan or health insurance 
          issuer from requiring prior authorization or imposing other 
          appropriate utilization controls in approving coverage for any 
          chemotherapy.''.
      (2) Section 731(c) of such Act (29 U.S.C. 1191(c)) is amended by 
  striking ``section 711'' and inserting ``sections 711 and 716''.
      (3) Section 732(a) of such Act (29 U.S.C. 1191a(a)) is amended by 
  striking ``section 711'' and inserting ``sections 711 and 716''.
      (4) The table of contents in section 1 of such Act is amended by 
  inserting after the item relating to section 714 the following new 
  items:
  
  ``Sec. 715. Additional market reforms.
  ``Sec. 716. Parity in coverage for oral anticancer drugs.''.
      (b) Public Health Service Act Amendments.--(1) Title XXVII of the 
  Public Health Service Act is amended by inserting after section 2728 
  (42 U.S.C. 300gg-28), as redesignated by section 1001(2) of the Patient 
  Protection and Affordable Care Act (Public Law 111-148), the following 
  new section:
  
  ``SEC. 2729. PARITY IN COVERAGE FOR ORAL ANTICANCER DRUGS.
  
      ``(a) In General.--Subject to subsection (b), a group health plan, 
  and a health insurance issuer offering group or individual health 
  insurance coverage, that provides benefits with respect to 
  intravenously administered or injected anticancer medications shall 
  provide for no less favorable coverage for prescribed, orally 
  administered anticancer medication that is used to kill or slow the 
  growth of cancerous cells and that has been approved by the Food and 
  Drug Administration.
      ``(b) Limitation.--Subsection (a) shall only apply to anticancer 
  medication that is prescribed based on a finding by the treating 
  physician that the medication--
              ``(1) is medically necessary for the purpose of killing or 
          slowing the growth of cancerous cells in a manner that is in 
          accordance with nationally accepted standards of medical 
          practice;
              ``(2) is clinically appropriate in terms of type, 
          frequency, extent site, and duration; and
              ``(3) is not primarily for the convenience of the patient, 
          physician, or other health care provider.
      ``(c) Application of Cost-Sharing and Restrictions.--
              ``(1) In general.--The coverage of anticancer medication 
          under subsection (a) may be subject to annual deductibles and 
          coinsurance or copayments so long as such deductibles, 
          coinsurance, and copayments do not exceed the deductibles, 
          coinsurance, and copayments that are applicable to 
          intravenously administered or injected anticancer medications 
          under the plan or coverage for the same purpose.
              ``(2) Restriction.--A group health plan or health insurance 
          issuer may not, in order to comply with the requirement of 
          subsection (a)--
                      ``(A) impose an increase in out-of-pocket costs 
                  with respect to anticancer medications; or
                      ``(B) reclassify benefits with respect to 
                  anticancer medications.
      ``(d) Application of Notice, Prohibitions, Etc.--The provisions of 
  subsections (b), (c), (d), and (e)(2) of section 713 of the Employee 
  Retirement and Income Security Act of 1974 shall apply with respect to 
  the coverage required by subsection (a) in the same manner as they 
  apply with respect to the coverage required under such section, except 
  that January 1, 2012, shall be substituted for the date referred to in 
  subsection (b)(3) of such section.
      ``(e) Construction.--Nothing in this section shall be construed--
              ``(1) to require the use of orally administered anticancer 
          medications as a replacement for other anticancer medications; 
          or
              ``(2) to prohibit a group health plan or health insurance 
          issuer from requiring prior authorization or imposing other 
          appropriate utilization controls in approving coverage for any 
          chemotherapy.''.
      (2) Section 2724(c) of such Act (42 U.S.C. 300gg-23(c)), as 
  redesignated by section 1001(4) and subsection (c)(14) of the section 
  1563 (relating to conforming amendments) of Public Law 111-148, is 
  amended by striking ``section 2704'' and inserting ``sections 2725 and 
  2729''.
      (3) Section 2762(b)(2) of such Act (42 U.S.C. 300gg-62(b)(2)) is 
  amended by striking ``section 2751'' and inserting ``sections 2751 and 
  2729''.
      (4) For purposes of applying section 2729 of the Public Health 
  Service Act, as inserted by paragraph (1), to individual health 
  insurance coverage before 2014, the provisions of such section shall be 
  treated as also included under part B of title XXVII of the Public 
  Health Service Act.
      (c) Internal Revenue Code Amendments.--
              (1) In general.--Subchapter B of chapter 100 of the 
          Internal Revenue Code of 1986, as amended by subsection (f) of 
          the section 1563 (relating to conforming amendments) of Public 
          Law 111-148, is amended by adding at the end the following new 
          section:
  
  ``SEC. 9816. PARITY IN COVERAGE FOR ORAL ANTICANCER DRUGS.
  
      ``(a) In General.--Subject to subsection (b), a group health plan 
  that provides benefits with respect to intravenously administered or 
  injected anticancer medications shall provide for no less favorable 
  coverage for prescribed, orally administered anticancer medication that 
  is used to kill or slow the growth of cancerous cells and that has been 
  approved by the Food and Drug Administration.
      ``(b) Limitation.--Subsection (a) shall only apply to anticancer 
  medication that is prescribed based on a finding by the treating 
  physician that the medication--
              ``(1) is medically necessary for the purpose of killing or 
          slowing the growth of cancerous cells in a manner that is in 
          accordance with nationally accepted standards of medical 
          practice;
              ``(2) is clinically appropriate in terms of type, 
          frequency, extent site, and duration; and
              ``(3) is not primarily for the convenience of the patient, 
          physician, or other health care provider.
      ``(c) Application of Cost-Sharing and Restrictions.--
              ``(1) In general.--The coverage of anticancer medication 
          under subsection (a) may be subject to annual deductibles and 
          coinsurance or copayments so long as such deductibles, 
          coinsurance, and copayments do not exceed the deductibles, 
          coinsurance, and copayments that are applicable to 
          intravenously administered or injected anticancer medications 
          under the plan for the same purpose.
              ``(2) Restriction.--A group health plan may not, in order 
          to comply with the requirement of subsection (a)--
                      ``(A) impose an increase in out-of-pocket costs 
                  with respect to anticancer medications; or
                      ``(B) reclassify benefits with respect to 
                  anticancer medications.
      ``(d) Application of Notice, Prohibitions, Etc.--The provisions of 
  subsections (b), (c), (d), and (e)(2) of section 713 of the Employee 
  Retirement and Income Security Act of 1974 shall apply with respect to 
  the coverage required by subsection (a) in the same manner as they 
  apply with respect to the coverage required under such section, except 
  that January 1, 2012, shall be substituted for the date referred to in 
  subsection (b)(3) of such section.
      ``(e) Construction.--Nothing in this section shall be construed--
              ``(1) to require the use of orally administered anticancer 
          medications as a replacement for other anticancer medications; 
          or
              ``(2) to prohibit a group health plan or health insurance 
          issuer from requiring prior authorization or imposing other 
          appropriate utilization controls in approving coverage for any 
          chemotherapy.''.
              (2) Clerical amendment.--The table of sections for such 
          subchapter is amended by adding at the end the following new 
          items:
  
  ``Sec. 9815. Additional market reforms.
  ``Sec. 9816. Parity in coverage for oral anticancer drugs.''.
      (d) Clarifying Amendment Regarding Application to Grandfathered 
  Plans.--Section 1251(a)(4)(A) of the Patient Protection and Affordable 
  Care Act (Public Law 111-148; 42 U.S.C. 18011(a)(4)(A)), as added by 
  section 2301(a) of Public Law 111-152, is amended by adding at the end 
  the following new clause:
                              ``(v) Section 2729 (relating to standards 
                          relating to benefits for minor child's 
                          congenital or developmental deformity or 
                          disorder), as added by section 2(b) of the 
                          Cancer Drug Coverage Parity Act of 2011.''.
      (e) Effective Date.--The amendments made by this section shall 
  apply with respect to group health plans for plan years beginning on or 
  after January 1, 2012, and with respect to health insurance coverage 
  offered, sold, issued, renewed, in effect, or operated in the 
  individual market on or after such date.
      (f) Study.--Not later than 2 years after the date of the enactment 
  of this Act--
              (1) the Medicare Payment Advisory Commission shall complete 
          a study that assesses how closing the Medicare part D donut 
          hole under the amendments made by section 3301 of the Patient 
          Protection and Affordable Care Act (Public Law 111-148), as 
          amended by section 1101 of the Health Care and Education 
          Reconciliation Act of 2010 (Public Law 111-152), affects 
          Medicare coverage for orally administered anticancer 
          medications, with a particular focus on cost and accessibility; 
          and
              (2) submit a report to Congress on the results of such 
          study.
target: Cancer Drug Coverage Parity Act of 2011 - Amends the Employee Retirement Income Security Act of 1974 (ERISA), the Public Health Service Act, and the Internal Revenue Code to require a group or individual health plan providing benefits for intravenously administered or injected anticancer medications to provide no less favorable coverage for prescribed, orally administered anticancer medication that is used to kill or slow the growth of cancerous cells and that has been approved by the Food and Drug Administration (FDA).
  
  Applies such requirement to medication that is prescribed based on a finding by the treating physician that the medication is: (1) medically necessary for the purpose of killing or slowing the growth of cancerous cells in accordance with nationally accepted standards of medical practice; (2) clinically appropriate in terms of type, frequency, extent site, and duration; and (3) not primarily for the convenience of the patient, physician, or other health care provider.
  
  Permits such coverage to be subject to the same cost-sharing applicable to intravenously administered or injected anticancer medications under the plan.
  
   Prohibits a health plan from imposing an increase in out-of-pocket costs, or reclassifying benefits, with respect to anticancer medications.
  
  Requires a plan to provide notice to each participant and beneficiary regarding the coverage required under this Act.
  
  Prohibits a health plan from taking specified actions to avoid the requirements of this Act.
  
  Requires the Medicare Payment Advisory Commission to assess how closing the Medicare part D donut hole affects Medicare coverage for orally administered anticancer medications, with a particular focus on cost and accessibility.
feat_title: To amend the Employee Retirement Income Security Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to require group and individual health insurance coverage and group health plans to provide for coverage of oral anticancer drugs on terms no less favorable than the coverage provided for intravenously administered anticancer medications.