Oral Chemo Drugs Must Cost the Same as IV Treatments Under New Parity Act Starting 2026

The Cancer Drug Parity Act of 2025 is straightforward: if you have a group health plan that covers IV cancer drugs administered by a doctor, that plan must treat the cost-sharing for oral chemotherapy pills (the ones you take at home) exactly the same. We’re talking about parity for deductibles, copayments, and coinsurance. This change is set to kick in for plan years beginning on or after January 1, 2026.

The Chemo Cost-Share Problem Solved

Historically, insurance plans often classified IV chemotherapy as a medical benefit (meaning lower out-of-pocket costs) but categorized oral chemotherapy pills as a pharmacy benefit (often leading to high, uncapped copays). This meant a patient could be stuck paying thousands more for a pill form of treatment than they would for the equivalent infusion, even if the pill was medically necessary. This bill, found in Section 2, closes that gap. If an FDA-approved oral cancer drug is prescribed because it is “medically necessary” or “clinically appropriate,” your plan can’t make you pay more for it than the IV version. For a patient managing cancer, this could mean the difference between bankruptcy and stable treatment, ensuring the prescribed form of chemo isn’t dictated by your wallet.

No Sneaky Workarounds Allowed

The legislation anticipates that insurance plans might try to adjust benefits to offset this new requirement. Section 2 explicitly prohibits plans from increasing cost-sharing caps or reclassifying benefits just to make oral drugs more expensive. They also can’t impose stricter limits—like higher prior authorization hurdles—on the oral drugs than they do on the IV drugs. This is key because it stops plans from playing shell games with the fine print. If your state already has a better law protecting oral chemo coverage, that stronger state law remains in effect, which is a nice piece of consumer protection.

The Fine Print: What’s Not Covered

It’s important to note what this bill doesn't do. It doesn't force a plan to cover oral chemotherapy if it doesn't already cover IV chemotherapy. More importantly, the required parity only applies when the doctor determines the oral drug is “medically necessary” or “clinically appropriate.” This is an area of medium vagueness (Section 2), as the definition of “medically necessary” can sometimes be a point of friction between patients, doctors, and insurers. If a plan decides a drug isn't necessary, the parity requirement doesn't apply, potentially leading to coverage disputes.

Watching the Watchers

To ensure this change actually works as intended, Section 3 mandates that the Government Accountability Office (GAO) conduct a study within two years of the law’s enactment. The GAO will compare the out-of-pocket costs for people using oral chemo under these new parity rules versus those who aren't covered by them. The goal is to see if the law truly lowers financial barriers and to suggest any further steps Congress should take. This built-in oversight means we’ll get a federal scorecard on whether this policy delivers on its promise to reduce financial strain for cancer patients.