{"entity":{"id":"idea-cost-federal-oral-parity","kind":"idea","name":"Federal oral chemotherapy parity for self-funded employer plans","aka":[],"tldr":"Most states require insurers to charge no more for a cancer pill than for an infusion, but the law does not reach the self-funded employer plans that cover most working Americans; a federal rule would close the gap.","summary":"Oral anticancer drugs are usually covered under the pharmacy benefit with coinsurance on a specialty tier, while infused drugs fall under the medical benefit with a copay. Forty-three states and the District of Columbia have parity laws, but the federal ERISA statute exempts self-funded employer plans, which cover roughly two-thirds of workers with employer coverage. The Cancer Drug Parity Act has been introduced in successive Congresses to apply parity to all plans.","asOf":"2026-09-10","links":[{"label":"Congress.gov: Cancer Drug Parity Act, H.R. 1730 (118th Congress)","url":"https://www.congress.gov/bill/118th-congress/house-bill/1730"}],"tags":[],"related":[],"cancers":[],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["financial-toxicity"],"trials":[],"people":[],"bottlenecks":["b-drug-pricing","b-regulatory-fragmentation"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"hypothesis":"Federal parity will reduce the share of oral oncology prescriptions abandoned at the pharmacy for cost reasons among self-funded plan members by more than a third, at a premium cost of well under 1%.","rationale":"State parity laws had small premium effects and reduced high out-of-pocket bills; the excluded population is the largest remaining group.","test":"Enactment followed by claims-based evaluation of abandonment rates and out-of-pocket costs in self-funded plans against state-regulated plans.","maturity":"early-clinical","actor":"policy","cost":"small","horizonYears":2},"route":"/ideas/idea-cost-federal-oral-parity/","neighbours":{"term":[{"id":"financial-toxicity","kind":"term","name":"Financial toxicity","route":"/terms/financial-toxicity/"}],"bottleneck":[{"id":"b-drug-pricing","kind":"bottleneck","name":"Prices and value","route":"/bottlenecks/b-drug-pricing/"},{"id":"b-regulatory-fragmentation","kind":"bottleneck","name":"Regulatory divergence between regions","route":"/bottlenecks/b-regulatory-fragmentation/"}]}}