Bill Text: NJ A797 | 2024-2025 | Regular Session | Introduced
Bill Title: Limits upfront costs for oral anticancer medications for persons covered under certain health benefits plans.
Spectrum: Partisan Bill (Republican 2-0)
Status: (Introduced) 2024-01-09 - Introduced, Referred to Assembly Education Committee [A797 Detail]
Download: New_Jersey-2024-A797-Introduced.html
STATE OF NEW JERSEY
221st LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2024 SESSION
Sponsored by:
Assemblyman GREGORY P. MCGUCKIN
District 10 (Monmouth and Ocean)
SYNOPSIS
Limits upfront costs for oral anticancer medications for persons covered under certain health benefits plans.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning health benefits coverage for oral anticancer medications and amending various parts of the statutory law.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 1 of P.L.2011, c.188 (C.17:48-6jj) is amended to read as follows:
1. a. A hospital service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the contract provides for intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. A hospital service corporation contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act.
d. Except for any copayment, deductible or coinsurance required to be paid by the covered person pursuant to the contract, a contract shall not require a covered person to pay any additional upfront cost or out of pocket expense for orally administered anticancer medications, even if reimbursement for that cost or expense is to be provided to the covered person at a later date.
e. This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
(cf: P.L.2011, c.188, s.1)
2. Section 2 of P.L.2011, c.188 (C.17:48A-7gg) is amended to read as follows:
2. a. A medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the contract provides for intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. A medical service corporation contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act.
d. Except for any copayment, deductible or coinsurance required to be paid by the covered person pursuant to the contract, a contract shall not require a covered person to pay any additional upfront cost or out of pocket expense for orally administered anticancer medications, even if reimbursement for that cost or expense is to be provided to the covered person at a later date.
e. This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
(cf: P.L.2011, c.188, s.2)
3. Section 3 of P.L.2011, c.188 (C.17:48E-35.34) is amended to read as follows:
3. a. A health service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the contract provides for intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. A health service corporation contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act.
d. Except for any copayment, deductible or coinsurance required to be paid by the covered person pursuant to the contract, a contract shall not require a covered person to pay any additional upfront cost or out of pocket expense for orally administered anticancer medications, even if reimbursement for that cost or expense is to be provided to the covered person at a later date.
e. This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
(cf: P.L.2011, c.188, s.3)
4. Section 4 of P.L.2011, c.188 (C.17B:26-2.1dd) is amended to read as follows:
4. a. An individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to N.J.S.17B:26-1 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the policy provides for intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. An individual health insurance policy shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the policy as of the effective date of this act.
d. Except for any copayment, deductible or coinsurance required to be paid by the covered person pursuant to the policy, a policy shall not require an insured to pay any additional upfront cost or out of pocket expense for orally administered anticancer medications, even if reimbursement for that cost or expense is to be provided to the covered person at a later date.
e. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
(cf: P.L.2011, c.188, s.4)
5. Section 5 of P.L.2011, c.188 (C.17B:27-46.1jj) is amended to read as follows:
5. a. A group health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the policy provides for intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. A group health insurance policy shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the policy as of the effective date of this act.
d. Except for any copayment, deductible or coinsurance required to be paid by the covered person pursuant to the policy, a policy shall not require a covered person to pay any additional upfront cost or out of pocket expense for orally administered anticancer medications, even if reimbursement for that cost or expense is to be provided to the covered person at a later date.
e. This section shall apply to those policies in which the insurer has reserved the right to change the premium.
(cf: P.L.2011, c.188, s.5)
6. Section 6 of P.L.2011, c.188 (C.17B:27A-7.17) is amended to read as follows:
6. a. An individual health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the plan provides for intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. An individual health benefits plan shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the plan as of the effective date of this act.
d. Except for any copayment, deductible or coinsurance required to be paid by the covered person pursuant to the health benefits plan, a health benefits plan shall not require a covered person to pay any additional upfront cost or out of pocket expense for orally administered anticancer medications, even if reimbursement for that cost or expense is to be provided to the covered person at a later date.
e. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
(cf: P.L.2011, c.188, s.6)
7. Section 7 of P.L.2011, c.188 (C.17B:27A-19.21) is amended to read as follows:
7. a. A small employer health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the plan provides for intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. A small employer health benefits plan shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the plan as of the effective date of this act.
d. Except for any copayment, deductible or coinsurance required to be paid by the covered person pursuant to the health benefits plan, a health benefits plan shall not require a covered person to pay any additional upfront cost or out of pocket expense for orally administered anticancer medications, even if reimbursement for that cost or expense is to be provided to the covered person at a later date.
e. This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
(cf: P.L.2011, c.188, s.7)
8. Section 8 of P.L.2011, c.188 (C.26:2J-4.35) is amended to read as follows:
8. a. A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide health care services for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the contract provides for covered intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. A health maintenance organization contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act.
d. Except for any copayment, deductible or coinsurance required to be paid by the covered person pursuant to the contract, a contract shall not require a covered person to pay any additional upfront cost or out of pocket expense for orally administered anticancer medications, even if reimbursement for that cost or expense is to be provided to the covered person at a later date.
e. This section shall apply to those contracts for health care services under which the right to change the schedule of charges for enrollee coverage is reserved.
(cf: P.L.2011, c.188, s.8)
9. Section 9 of P.L.2011, c.188 (C.52:14-17.29r) is amended to read as follows:
9. a. The State Health Benefits Commission shall ensure that every contract purchased on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the contract provides for intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. A State Health Benefits Commission contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act.
d. Except for any copayment, deductible or coinsurance required to be paid by the covered person pursuant to the contract, a contract shall not require a covered person to pay any additional upfront cost or out of pocket expense for orally administered anticancer medications, even if reimbursement for that cost or expense is to be provided to the covered person at a later date.
(cf: P.L.2011, c.188, s.9)
10. Section 10 of P.L.2011, c.188 (C.52:14-17.46.6c) is amended to read as follows:
10. a. The School Employees' Health Benefits Commission shall ensure that every contract purchased on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the contract provides for intravenously administered or injected anticancer medications.
b. Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c. A School Employees' Health Benefits Commission contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act.
d. Except for any copayment, deductible or coinsurance required to be paid by the covered person pursuant to the contract, a contract shall not require a covered person to pay any additional upfront cost or out of pocket expense for orally administered anticancer medications, even if reimbursement for that cost or expense is to be provided to the covered person at a later date.
(cf: P.L.2011, c.188, s.10)
11. This act shall take effect immediately and shall apply to all contracts and policies issued on or after the effective date.
STATEMENT
This bill limits the amount that a covered person is required to pay upfront in order to obtain oral anticancer medications by amending P.L.2011, c. 188, which requires health insurers, the State Health Benefits Program, and the School Employees' Health Benefits Program to cover oral anticancer medications on a basis no less favorable than intravenous anticancer medications.
Specifically, the bill provides that, except for any copayment, deductible or coinsurance required to be paid by the covered person pursuant to the contract or policy, a contract or policy shall not require a covered person to pay any additional upfront cost or out of pocket expense for orally administered anticancer medications, even if reimbursement for that cost or expense is to be provided to the covered person at a later date.
Due to the extremely high cost of many oral anticancer medications, many patients cannot afford to pay for these medications upfront and wait for reimbursement from their insurer or health benefits plan at a later date. This bill attempts to remedy these situations by limiting upfront costs to the patient's copayment, deductible or coinsurance.
