SPONSOR: |
Rep. Hudson & Rep. Briggs King & Rep. B.
Short & Sen. Blevins & Sen. Sorenson ; |
|
Reps.
Bennett, Bolden, Manolakos, Ramone, Gilligan, J. Johnson, Q. Johnson, Keeley,
Longhurst, Walker, D.E. Williams; Sens. Cloutier, Connor, DeLuca, Ennis,
Hall-Long, Henry, Peterson, Sokola |
HOUSE OF REPRESENTATIVES 146th GENERAL ASSEMBLY |
HOUSE BILL NO. 265 |
AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO HEALTH INSURANCE COVERAGE FOR ORAL AND INTRAVENOUS ANTICANCER MEDICATIONS. |
WHEREAS, the Legislature finds that advances in medical research have led to significant new developments of various medical treatments; and
WHEREAS, these treatments offer patients a wide range of new choices to combat very serious diseases; and
WHEREAS, the area of cancer treatment has been one of the fields that has seen these significant new medical advancements; and
WHEREAS, in recent years, oral anticancer medications have been developed that provide viable alternatives to traditional intravenous anticancer treatments for patients; and
WHEREAS, these oral anticancer medications offer the treating physician and the patient a choice in relation to treatment options; and
WHEREAS, this choice is sometimes limited because the oral anticancer medications are, in most cases, covered under the prescription drug benefit of an insurance plan rather than under the major medical insurance benefit of an insurance plan; and
WHEREAS, this discrepancy in coverage can limit a patient’s ability to choose an oral anticancer medication because of the cost associated with the disparate treatment;
NOW, THEREFORE:
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:
Section 1. Amend Chapter 33, Title 18 of the Delaware Code by making insertions as shown by underlining and deletions as shown by strike through as follows:
§
3338A. Equal reimbursement for oral and
intravenous anticancer medication.
(a) Every individual policy or contract
of health insurance, or certificate issued thereunder, which is delivered,
issued for delivery, renewed, modified, altered, or amended in this State on or
after January 1, 2013, and which provides medical, major medical, or similar
comprehensive-type coverage, and provides coverage for prescription drugs, and
which also provides coverage for anticancer medication, must provide coverage
for a prescribed, orally administered anticancer medication used to kill or
slow the growth of cancerous cells, and must apply the lower cost sharing of
either:
(1) anticancer
medication under the prescription drug benefit, or
(2) intravenous or injected anticancer medications.
For purposes of this section, the term ‘cost sharing’ may include
co-pays, coinsurance, and deductibles, as considered appropriate by the
Commissioner.
(b) An insurer who provides coverage
under this section and any participating entity through which the insurer
offers health services may not:
(1) Vary
the terms of the policy for the purpose of or with the effect of avoiding
compliance with this section;
(2) Provide
incentives, monetary or otherwise, to encourage a covered person to accept less
than the minimum protections available under this section;
(3) Penalize
in any way or reduce or limit the compensation of a healthcare practitioner for
recommending or providing care to a covered person in accordance with this
section;
(4) Provide
incentives, monetary or otherwise, to a healthcare practitioner relating to the
services provided pursuant to this section, intended to induce or have the
effect of inducing the practitioner to provide care to a covered person in a
manner inconsistent with this section; or
(5) Achieve
compliance with this section by imposing an increase in cost sharing for an oral,
intravenous, or injected anticancer medication covered under the policy on and
following the effective date of this act.
(c) Nothing in this section may be interpreted to prohibit an
insurer from requiring prior authorization for any anticancer treatment.
(d) Nothing in this section may be interpreted to require
coverage for anticancer medication.
Section 2. Amend Chapter 35, Title 18 of the Delaware Code by making insertions as shown by underlining and deletions as shown by strike through as follows:
§
3555A. Equal reimbursement for oral and
intravenous anticancer medication.
(a) Every group or blanket policy or
contract of health insurance, or certificate issued thereunder, which is
delivered, issued for delivery, renewed, modified, altered, or amended in this
State on or after January 1, 2013, and which provides medical, major medical,
or similar comprehensive-type coverage, and provides coverage for prescription
drugs, and which also provides coverage for anticancer medication, must provide
coverage for a prescribed, orally administered anticancer medication used to
kill or slow the growth of cancerous cells, and must apply the lower cost
sharing of either:
(1) anticancer
medication under the prescription drug benefit, or
(2) intravenous or
injected anticancer medications.
For purposes of this section, the term ‘cost sharing’ may
include co-pays, coinsurance, and deductibles, as considered appropriate by the
Commissioner.
(b) An insurer who provides coverage
under this section and any participating entity through which the insurer
offers health services may not:
(1) Vary the terms
of the policy for the purpose of or with the effect of avoiding compliance with
this section;
(2) Provide
incentives, monetary or otherwise, to encourage a covered person to accept less
than the minimum protections available under this section;
(3) Penalize in any
way or reduce or limit the compensation of a healthcare practitioner for
recommending or providing care to a covered person in accordance with this
section;
(4) Provide
incentives, monetary or otherwise, to a healthcare practitioner relating to the
services provided pursuant to this section, intended to induce or have the
effect of inducing the practitioner to provide care to a covered person in a
manner inconsistent with this section; or
(5) Achieve
compliance with this section by imposing an increase in cost sharing for an
oral, intravenous, or injected anticancer medication covered under the policy
on and following the effective date of this act.
(c) Nothing in this section may be
interpreted to prohibit an insurer from requiring prior authorization for any anticancer
treatment.
(d) Nothing
in this section may be interpreted to require coverage for anticancer
medication.
Section 3. This Act is “The Delaware Cancer Treatment Access Act.”
SYNOPSIS
This bill is based on New York’s oral parity law, which requires insurance companies to make equal reimbursement for oral and intravenous anticancer medications. Section 1 applies to individual health insurance policies. Section 2 applies to group or blanket policies. The coverage provisions of Sections 1 and 2 are identical. The bill applies to health insurance policies issued, renewed, or amended on or after January 1, 2013. This act is “The Delaware Cancer Treatment Access Act.” |