Unequal Treatment: Addressing the Drivers of Unaffordability for Oral Chemotherapy

This was a hearing of the GOP Oversight subcommittee on healthcare and financial services held on September 16, 2026, focused on the unaffordability of oral chemotherapy drugs compared to intravenous (IV) chemotherapy. The discussion centered on the disparities in insurance coverage and out-of-pocket costs for oral cancer drugs, which are often covered under pharmacy benefits with higher co-insurance and no caps, versus IV drugs covered under medical benefits. Witnesses highlighted the role of pharmacy benefit managers (PBMs) and insurers in driving up costs through rebates, formulary restrictions, and prior authorization delays. The committee discussed the bipartisan Cancer Drug Parity Act (HR 4101), which aims to require employer-sponsored health plans to provide cost-sharing for oral cancer drugs on terms no less favorable than IV drugs, addressing gaps left by state laws that do not cover self-funded employer plans. Testimony emphasized the need for broader reforms including streamlined prior authorization, prohibiting fail-first therapy mandates, and increased transparency and competition in drug pricing. The hearing also touched on the impact of vertical integration in healthcare and the importance of federal and state collaboration to improve coverage and affordability for cancer patients.