New Hampshire program
Help with the cost of cancer pills (oral chemotherapy parity)
New Hampshire limits certain cancer-pill charges by comparing them with injected cancer treatment on covered insurance plans.
What it is
New Hampshire limits certain cancer-pill charges by comparing them with injected cancer treatment on covered insurance plans.
Cancer pills bring pharmacy charges separate from clinic bills. On an insured policy the pill's charge cannot be higher than injected chemo's, or the plan caps it at $200 a fill. A high-deductible plan applies its deductible first, and a plan where the employer pays its own claims is outside the rule; HR can say which yours is.
Eligibility rules
- The rule covers individual and group accident or health policies issued or renewed in New Hampshire. Both forms of cancer medicine must be covered.
- It applies only when injected or intravenous treatment is not medically appropriate.
- Self-funded employer plans are outside this state rule. Medicaid uses its own charges.
What you get
- Lower pill charges when the plan must match the injected-treatment charge.
- A review of the pharmacy claim and a refund if the charge is corrected.
What the protection includes
- A plan is treated as complying when cost sharing is $200 or less per prescription fill.
- Income-replacement and fixed-payment policies are outside the rule.
If you decide to apply
- Ask the pharmacy team for the pill receipt and the comparable injected-treatment charge.
- Ask your insurer to review the claim in writing, with help from the social worker if needed.
Your insurer’s pharmacy benefits team · Official page ↗
After you ask
- The plan can reprocess the claim and refund the difference when it agrees the charge was wrong.
Good to know
This is not a universal $200 cap. A high-deductible plan is exempt until the year’s deductible is met.
Other details
- The law took effect January 1, 2017.
- An insurance card or an employer’s name does not by itself tell us which law applies. NH Insurance Department can check the actual policy, where it was issued, whether benefits are insured or self-funded, and whether it is a public, church or federal employee plan. Private-employer self-funded ERISA plans are generally outside NH insurance benefit mandates. A state, teacher or municipal job does not by itself prove inclusion or exclusion; government plans are not all ERISA plans.
Official sources
- RSA 415:6-t, Oral Anti-Cancer Therapies (individual policies)
- RSA 415:18-y, Oral Anti-Cancer Therapies (group policies)
- 420 J 6.htm — gc.nh.gov
- 420 J 7 b.htm — gc.nh.gov
- 420 J 5 a.htm — gc.nh.gov
- 420 J 5 b.htm — gc.nh.gov
- 420 J 5 c.htm — gc.nh.gov
- 417 G 2.htm — gc.nh.gov
- 420 J 20.htm — gc.nh.gov
- 420 J 21.htm — gc.nh.gov
- 420 J 22.htm — gc.nh.gov
- 415 18.htm — gc.nh.gov
- 420 J 2.htm — gc.nh.gov
“If our child needs chemo pills, does this rule change what we would pay? Could you help compare the plan’s charges and any exceptions?”
Why I’m asking: I want to understand whether pharmacy charges qualify for a reduction.
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 two charges and ask the plan in writing to match them.
Your social worker
The pharmacy team gives you the injected-chemo charge to compare against.
The care team
Records and letters when the application asks for them.
- Who decides
- The plan; the state Insurance Department enforces on insured plans.
- Ask HR
- “Is our plan insured or self-funded? If insured, New Hampshire does not allow a higher charge for the pills than for the drip.”
How to apply
First step: Ask the pharmacy for the receipt, ask the clinic what injected chemo costs you, and write to the plan if the pills cost more.
- Compare the pill charge with what the plan charges for injected chemo.
- If it is higher, ask the plan in writing to reprocess the claim.
Official application / program page ↗
Where it starts: Ask the pharmacy benefit in writing to reprocess the claim at the injected-chemo level.
What to gather
- The pharmacy receipt or explanation of benefits
- The injected-chemo charge
- The employer's answer on insured or self-funded
How long: On the next claim once the plan agrees.
What a yes looks like
The claim reprocessed at the injected-chemo level and the difference refunded.
What a no looks like, and the next move
The plan says it is self-funded, or points at the deductible on a high-deductible plan.
Watch out
- It matches the charge, it does not cap it.
- A high-deductible plan is exempt until the deductible is met.
- It applies only where the injected form is not medically appropriate.
If they say no, quote this: Oral anti-cancer therapies: RSA 415:6-t and RSA 415:18-y.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
The pill charge brought down to the injected-chemo charge on an insured plan. A plan is treated as complying at $200 or less a fill.
- $200 — Cost sharing per prescription fill at which a plan is treated as complying
Legal protection: No higher copayment, deductible or coinsurance for patient-administered anti-cancer medication than for the injected kind · Income replacement and fixed-payment policies are outside the rule
What it costs the family: The same charge as injected chemo, or no more than $200 a fill where the plan uses that route.
The eligibility facts, as published
- Plans
- individual and group accident or health policies issued or renewed in New Hampshire that cover both injected and patient-administered anti-cancer medication
- Limitation
- applies only where an injected or intravenous medication is not medically appropriate
- Hdhp
- exempt until the enrollee's deductible is met for the year
- Effective
- 2017-01-01
The trap: It matches, it does not cap. If the injected chemo has a big charge, the pills can too. And a plan is treated as complying if the pills cost no more than $200 a fill, which is a floor for the insurer, not a promise to you.
Where I read this
- RSA 415:6-t, Oral Anti-Cancer Therapies (individual policies) — NH General Court, read September 10, 2026
- RSA 415:18-y, Oral Anti-Cancer Therapies (group policies) — NH General Court, read September 10, 2026