Written by a parent, not a doctor. Nothing here is medical advice.

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Arkansas program

Check a high charge for oral cancer medicine

Arkansas limits what covered group plans can charge for cancer pills compared with injected or infused treatment.

What it is

Arkansas limits what covered group plans can charge for cancer pills compared with injected or infused treatment.

If a chemo pill comes with a high pharmacy charge, this law is the check. On a covered plan the pill's deductible, copay or coinsurance cannot be higher than for IV or injected chemo. It is a comparison, not a dollar cap, so the pill can still cost money.

Eligibility rules
  • The rule covers employer group plans regulated by Arkansas, including state and school employee plans. It does not cover individual marketplace plans.
  • A private employer's self-funded ERISA plan generally is outside this mandate. A public plan must not be excluded just because it pays its own claims.
  • For covered oral anticancer treatment, deductible, copay and coinsurance cannot exceed those for injected or intravenous anticancer treatment. This does not promise free medicine or coverage of every drug.
What you get
  • A limit on relative cancer-treatment costs for plans covered by Arkansas's law.
Coverage and limits
  • The law compares the copay, deductible and coinsurance for a pill with those for IV chemotherapy; it does not set a dollar cap, and a high bill is not automatically a wrong one.
If you decide to apply
  1. Ask the pharmacy for a record of the charge and the plan for its oral-cancer-drug provision.
  2. Ask the Insurance Department which rule applies to your plan.

Arkansas Insurance Department, 1-800-852-5494 · Official page ↗

After you apply
  • The plan can explain its calculation in writing. The pharmacy's charge record helps compare what was billed.
Good to know

State-employee and public-school-employee plans are covered. A plan bought on the Marketplace is not, and a plan where the employer pays its own claims usually is not either; HR can say which yours is.

Other details
  • An insurance-company logo alone does not establish whether an employer plan is self-funded.
Official sources
Ask your social worker

“Could the oral-cancer-drug rule change what we pay at the pharmacy? What limits apply, and could you help us ask the plan for a review if the charge seems wrong?”

Why I’m asking: I want to understand whether the way a cancer medicine is billed changes our costs.

More background and detailed requirements
Additional program information and published rules

Who does what

The three parts, side by side. The agency decides; nobody on this page does.

You

Compare the pharmacy charge with what the infusions cost you and write to the plan.

Your social worker

The pharmacy can print what you were charged.

The care team

Records and letters when the application asks for them.

Who decides
The health plan; the Insurance Department takes complaints.
Ask the billing office
“Arkansas has a law on cancer pills costing no more than the drip. Can you point me to the provision in our plan and tell me what we should be charged?”

How to apply

First step: When maintenance starts, ask the plan in writing to point to its oral-chemotherapy parity provision.

  1. If the pharmacy charge for the tablets is worse than the infusion charge, ask the plan in writing about Arkansas's parity law.

Official application / program page ↗

Where it starts: Ask the plan in writing to point to its oral-chemotherapy parity provision. Insurance Department consumer line: 1-800-852-5494.

What to gather

  • The pharmacy receipt
  • What the infusions cost you

How long: Ask the plan for an answer in writing.

What a yes looks like

The plan points to the provision and reprices the prescription.

What a no looks like, and the next move

Ask the Insurance Department consumer line on 1-800-852-5494 whether the law reaches your plan.

Watch out

  • The law compares deductible, copay and coinsurance; it does not set a fixed dollar cap.
  • Private self-funded ERISA plans generally fall outside the state mandate, but state/public-school plans are expressly included.

Dates that change this

2017-01-01: Act 543 of 2017 is codified at § 23-79-161, operative January 1, 2018. It compares covered oral and injected/IV treatment cost sharing for specified plans; individual Marketplace policies are excluded. (not yet confirmed against the final rule)

The numbers and the rules

The arcane layer, kept on purpose. Checked September 11, 2026.

What it is worth

Covered group plans must not charge higher cost sharing for covered oral anticancer treatment than injected or intravenous treatment.

Legal protection: A state law requiring parity between oral and intravenous anticancer medication

What it costs the family: None to ask.

The eligibility facts, as published

Plan type
Specified group and blanket plans, including state/public-school employee plans. Individual major-medical and Marketplace policies are expressly excluded; private self-funded ERISA plans generally are outside this mandate.

The trap: This is a comparison rule, not a fixed dollar cap. Individual Marketplace policies are excluded; Arkansas state/public-school plans are expressly included.

Where I read this

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