BILL NUMBER: SB 161 AMENDED
BILL TEXT
AMENDED IN SENATE MAY 21, 2009
AMENDED IN SENATE MAY 14, 2009
INTRODUCED BY Senator Wright
(Coauthor: Senator Alquist)
FEBRUARY 14, 2009
An act to add Section 1367.655 to the Health and Safety Code, and
to add Section 10123.205 to the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 161, as amended, Wright. 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 plans 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 require health care service plan contracts and
health insurance policies that provide coverage for cancer
chemotherapy treatment to provide coverage for a prescribed, orally
administered cancer medication, as specified, on a basis no less
favorable than intravenously administered or injected cancer
medications covered under the contracts or policies. The bill would
require a health care service plan or health insurer to review the
percentage cost share, as defined, for oral cancer medications and
intravenous or injected cancer medications and to apply the lower of
the 2 as the cost-sharing provision for oral cancer medications.
The bill would specify that its requirements do not apply to a
health care benefit plan, contract, or health insurance policy with
the Board of Administration of the Public Employees' Retirement
System.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.655 is added to the Health and Safety
Code, to read:
1367.655. (a) A health care service plan contract issued,
amended, or renewed on or after January 1, 2010, that provides
coverage for cancer chemotherapy treatment shall provide coverage for
a prescribed, orally administered cancer medication used to kill or
slow the growth of cancerous cells on a basis no less favorable than
intravenously administered or injected cancer medications covered
under the contract.
(b) In order to comply with subdivision (a), a health care service
plan shall review the percentage cost share for oral cancer
medications and intravenous or injected cancer medications and shall
apply the lower of the two as the cost-sharing provision for oral
cancer medications. A health care service plan contract shall not
provide for an increase in enrollee cost sharing for cancer
medications.
(c) For purposes of this section "cost share" means copayment,
coinsurance, or deductible provisions applicable to coverage for oral
or intravenous or injected cancer medications.
(d) This section shall not apply to a health care benefit plan or
contract entered into with the Board of Administration of the Public
Employees' Retirement System pursuant to the Public Employees'
Medical and Hospital Care Act (Part 5 (commencing with Section 22750)
of Division 5 of Title 2 of the Government Code).
SEC. 2. Section 10123.205 is added to the Insurance Code, to read:
10123.205. (a) A health insurance policy issued, amended, or
renewed on or after January 1, 2010, that provides coverage for
cancer chemotherapy treatment shall provide coverage for a
prescribed, orally administered cancer medication used to kill or
slow the growth of cancerous cells on a basis no less favorable than
intravenously administered or injected cancer medications covered
under the policy.
(b) In order to comply with subdivision (a), a health insurer
shall review the percentage cost share for oral cancer medications
and intravenous or injected cancer medications and shall apply the
lower of the two as the cost-sharing provision for oral cancer
medications. A health insurance policy shall not provide for an
increase in insured cost sharing for cancer medications.
(c) For purposes of this section "cost share" means copayment,
coinsurance, or deductible provisions applicable to coverage for oral
or intravenous or injected cancer medications.
(d) This section shall not apply to a policy of health insurance
purchased by the Board of Administration of the Public Employees'
Retirement System pursuant to the Public Employees' Medical and
Hospital Care Act (Part 5 (commencing with Section 22750) of Division
5 of Title 2 of the Government Code).
SEC. 3. 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.