Cancer Drug Coverage Parity Act of 2011

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.

Written by the nonpartisan Congressional Research Service. All summary versions on Congress.gov