Bill Text: CA AB219 | 2013-2014 | Regular Session | Chaptered
Bill Title: Health care coverage: cancer treatment.
Spectrum: Moderate Partisan Bill (Democrat 4-1)
Status: (Passed) 2013-10-10 - Chaptered by Secretary of State - Chapter 661, Statutes of 2013. [AB219 Detail]
Download: California-2013-AB219-Chaptered.html
BILL NUMBER: AB 219 CHAPTERED
BILL TEXT
CHAPTER 661
FILED WITH SECRETARY OF STATE OCTOBER 9, 2013
APPROVED BY GOVERNOR OCTOBER 9, 2013
PASSED THE SENATE SEPTEMBER 9, 2013
PASSED THE ASSEMBLY SEPTEMBER 10, 2013
AMENDED IN SENATE SEPTEMBER 4, 2013
AMENDED IN SENATE AUGUST 20, 2013
AMENDED IN SENATE JULY 2, 2013
AMENDED IN SENATE JUNE 19, 2013
AMENDED IN SENATE JUNE 17, 2013
INTRODUCED BY Assembly Member Perea
(Coauthors: Assembly Members Olsen, Wieckowski, and Williams)
(Coauthor: Senator Wright)
FEBRUARY 4, 2013
An act to add and repeal Section 1367.656 of the Health and Safety
Code, and to add and repeal Section 10123.206 of the Insurance Code,
relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 219, Perea. Health care coverage: cancer treatment.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires health care service plan contracts and health
insurance policies to provide coverage for all generally medically
accepted cancer screening tests and requires those contracts and
policies to also provide coverage for the treatment of breast cancer.
Existing law imposes various requirements on contracts and policies
that cover prescription drug benefits.
This bill would prohibit an individual or group health care
service plan contract or health insurance policy issued, amended, or
renewed on or after January 1, 2015, that provides coverage for
prescribed, orally administered anticancer medications used to kill
or slow the growth of cancerous cells from requiring an enrollee or
insured to pay, notwithstanding any deductible, a total amount of
copayments and coinsurance that exceeds $200 for an individual
prescription of up to a 30-day supply of a prescribed orally
administered anticancer medication. The bill would provide that for a
health care service plan contract or health insurance policy that
meets a specified federal definition of a high deductible health
plan, this prohibition shall only apply once the enrollee's or
insured's deductible has been satisfied for the year. The bill would
authorize a health care service plan or health insurer, on January 1,
2016, and on January 1 of each year thereafter, to increase the $200
limit by the percentage increase in the Consumer Price Index for
that year. The bill would repeal these provisions on January 1, 2019.
Because a willful violation of the bill's requirements relative to
health care service plans would be a crime, the bill would impose a
state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) The Legislature finds and declares that the
majority of prescriptions for oral anticancer medications are filled
by cancer patients at reasonable cost due to effective health plan or
health insurance coverage of the product or the low retail price of
the drug.
(b) It is the intent of the Legislature to help cancer patients
who do not have access to the most appropriate treatment for their
cancer because the terms of their health care service plan contract
or health insurance policy do not make the covered treatment
affordable.
(c) It is further the intent of the Legislature to set a maximum
total copayment and coinsurance amount that health care service plans
and health insurers can require patients to pay for a 30-day supply
of oral anticancer medication. The Legislature does not intend health
care service plans or health insurers to interpret that maximum to
be a target or desirable patient cost.
SEC. 2. Section 1367.656 is added to the Health and Safety Code,
to read:
1367.656. (a) Notwithstanding any other law, an individual or
group health care service plan contract issued, amended, or renewed
on or after January 1, 2015, that provides coverage for prescribed,
orally administered anticancer medications used to kill or slow the
growth of cancerous cells shall comply with all of the following:
(1) Notwithstanding any deductible, the total amount of copayments
and coinsurance an enrollee is required to pay shall not exceed two
hundred dollars ($200) for an individual prescription of up to a
30-day supply of a prescribed orally administered anticancer
medication covered by the contract.
(2) For a health care service plan contract that meets the
definition of a "high deductible health plan" set forth in Section
223(c)(2) of Title 26 of the United States Code, paragraph (1) shall
only apply once an enrollee's deductible has been satisfied for the
year.
(3) Paragraph (1) shall not apply to any coverage under a health
care service plan contract for the Medicare Program pursuant to Title
XVIII of the federal Social Security Act (42 U.S.C. Sec. 1395 et
seq.).
(4) On January 1, 2016, and on January 1 of each year thereafter,
health care service plans may adjust the two hundred dollar ($200)
limit described in paragraph (1). The adjustment shall not exceed the
percentage increase in the Consumer Price Index for that year.
(5) A prescription for an orally administered anticancer
medication shall be provided consistent with the appropriate standard
of care for that medication.
(b) This section shall remain in effect only until January 1,
2019, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2019, deletes or extends
that date.
SEC. 3. Section 10123.206 is added to the Insurance Code, to read:
10123.206. (a) Notwithstanding any other law, an individual or
group health insurance policy issued, amended, or renewed on or after
January 1, 2015, that provides coverage for prescribed, orally
administered anticancer medications used to kill or slow the growth
of cancerous cells shall comply with all of the following:
(1) Notwithstanding any deductible, the total amount of copayments
and coinsurance an insured is required to pay shall not exceed two
hundred dollars ($200) for an individual prescription of up to a
30-day supply of a prescribed orally administered anticancer
medication covered by the policy.
(2) For a health insurance policy that meets the definition of a
"high deductible health plan" set forth in Section 223(c)(2) of Title
26 of the United States Code, paragraph (1) shall only apply once an
insured's deductible has been satisfied for the year.
(3) Paragraph (1) shall not apply to any coverage under a health
insurance policy for the Medicare Program pursuant to Title XVIII of
the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.).
(4) On January 1, 2016, and on January 1 of each year thereafter,
health insurers may adjust the two hundred dollar ($200) limit
described in paragraph (1). The adjustment shall not exceed the
percentage increase in the Consumer Price Index for that year.
(5) A prescription for an orally administered anticancer
medication shall be provided consistent with the appropriate standard
of care for that medication.
(b) This section shall remain in effect only until January 1,
2019, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2019, deletes or extends
that date.
SEC. 4. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
