Wyoming program
Fairer charges for chemotherapy pills
Wyoming limits what covered health plans can charge families for chemotherapy taken by mouth.
What it is
Wyoming limits what covered health plans can charge families for chemotherapy taken by mouth.
A prescription bill can look very different from an infusion bill. On a policy Wyoming regulates, the tablet cannot carry higher deductibles, copays or coinsurance than the drip; it is a comparison, not a dollar cap. A plan where the employer pays its own claims is outside the rule; HR can say which yours is.
Who this can help
- The law covers qualifying individual and group insurance policies, service or indemnity contracts and HMO contracts.
- It applies to policies issued or renewed after July 1, 2015.
- This state rule applies to qualifying Wyoming insurance policies, including a Marketplace or grandfathered insured policy when it meets the law’s conditions. A public employee’s plan needs a funding and policy check; private self-funded ERISA plans are different. The comparison is with covered injected or IV anticancer treatment, not necessarily the identical medicine in another form.
What you get
- No higher cost sharing for covered oral chemotherapy than for injected or intravenous chemotherapy.
- A way to request correction of a pharmacy charge that breaks the rule.
What the help includes
- The rule covers copays, deductibles and coinsurance.
- A plan cannot comply by raising intravenous chemotherapy charges or reclassifying cancer drugs.
If you decide to apply
- Ask the pharmacist or social worker to compare the pharmacy charge with the plan's infusion charges.
- Gather the pharmacy receipt, insurance explanation and plan documents.
- If you decide to question the charge, the social worker can help ask the insurer whether Wyoming's parity rule applies and whether the claim should be reprocessed.
Health plan's claims office and Wyoming Department of Insurance · Official page ↗
After you ask
- If the insurer accepts that the rule applies, it can reprocess the claim using the proper cost sharing.
- If it refuses, the insurance department can help identify the complaint or review process.
Good to know
This rule compares charges. It does not set a fixed dollar cap for each prescription.
Other details
- A self-funded workplace plan is not automatically covered by this state requirement.
Official sources
“If chemotherapy pills cost more under our plan, does Wyoming's rule help, and what charges would remain? Could you help us ask the insurer to check the claim?”
Why I’m asking: I want to understand whether the pharmacy charge follows the rules for our plan.
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 write to the plan.
Your social worker
The pharmacist or social worker can confirm what the drip cost.
The care team
Records and letters when the application asks for them.
- Who decides
- The plan, with the insurance department behind it.
- Ask the billing office
- “Wyoming law says oral chemotherapy cannot cost more than the same chemotherapy by drip. Please reprocess this at the same cost sharing.”
How to apply
First step: Compare the pharmacy charge with the drip charge, and write to the plan if the tablet costs more.
- Compare the pharmacy charge with what the clinic charged for the drip.
- If the tablet costs more, write to the plan quoting the Wyoming parity rule.
- If it does not move, ring the insurance department on 1-800-438-5768.
Official application / program page ↗
Where it starts: Quote the rule to the plan in writing and copy the insurance department if it does not move.
What to gather
- The pharmacy receipt
- The explanation of benefits for the drip
- The plan documents
How long: The plan should reprocess once it accepts the rule applies. Otherwise the outside review route is open.
What a yes looks like
The claim reprocessed at the same cost sharing as the drip.
What a no looks like, and the next move
Usually the plan says it is self-funded. Ask the benefits office to confirm, in writing.
Watch out
- It is parity, not a price cap; it stops the tablet costing more than the drip.
- It does not automatically reach a self-funded workplace plan.
- Whether it reaches a state-employee or teacher plan was not established; ask your benefits office.
The numbers and the rules
The arcane layer, kept on purpose. Checked September 11, 2026.
What it is worth
A Wyoming-regulated plan cannot charge more for chemotherapy tablets than for the same drug by drip.
Legal protection: No higher copay, deductible or coinsurance for oral chemotherapy than for injected or intravenous chemotherapy · A plan cannot comply by raising the cost of the drip or by reclassifying cancer drugs
What it costs the family: None to rely on it.
The eligibility facts, as published
- Plan
- individual and group health insurance policies on an expense-incurred basis, service or indemnity contracts, and health maintenance organisation contracts
- Timing
- issued or renewed after July 1, 2015
- Unresolved
- self-funded, marketplace, grandfathered and public-employee plan classification was not established
The trap: It is a parity rule, not a dollar cap. It says the tablet cannot cost more than the drip; it does not put a ceiling on either.
Where I read this
- Wyoming Statutes, Title 26 (Insurance Code) — Wyoming Legislature, read September 10, 2026