Bill Text: NY S06055 | 2011-2012 | General Assembly | Introduced
Bill Title: Relates to coverage for oral chemotherapy.
Spectrum: Slight Partisan Bill (Democrat 2-1)
Status: (Introduced - Dead) 2012-02-06 - SUBSTITUTED BY A8906 [S06055 Detail]
Download: New_York-2011-S06055-Introduced.html
S T A T E O F N E W Y O R K ________________________________________________________________________ 6055 I N S E N A T E (PREFILED) January 4, 2012 ___________ Introduced by Sen. LANZA -- read twice and ordered printed, and when printed to be committed to the Committee on Insurance AN ACT to amend the insurance law, in relation to coverage of oral chemotherapy treatment THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM- BLY, DO ENACT AS FOLLOWS: 1 Section 1. Paragraph 12-a of subsection (i) of section 3216 of the 2 insurance law, as added by chapter 559 of the laws of 2011, is amended 3 to read as follows: 4 (12-a) (A) Every policy delivered or issued for delivery in this state 5 that provides medical, major medical, or similar comprehensive-type 6 coverage and provides coverage for prescription drugs and also [provide] 7 PROVIDES coverage for cancer chemotherapy treatment shall provide cover- 8 age for [a] prescribed, orally administered anticancer [medication] 9 MEDICATIONS used to kill or slow the growth of cancerous cells [and 10 shall apply the lower cost sharing of either (i) anticancer medication 11 under the prescription drug benefit or (ii)]. SUCH COVERAGE MAY BE 12 SUBJECT TO CO-PAYS, COINSURANCE OR DEDUCTIBLES, PROVIDED THAT THE 13 CO-PAYS, COINSURANCE OR DEDUCTIBLES ARE AT LEAST AS FAVORABLE TO AN 14 INSURED AS THE CO-PAYS, COINSURANCE OR DEDUCTIBLES THAT APPLY TO COVER- 15 AGE FOR intravenous or injected anticancer medications. [For the 16 purposes of this section "cost sharing" shall include co-pays, coinsu- 17 rance, and deductibles as deemed appropriate by the superintendent.] 18 (B) An insurer providing coverage under this paragraph and any partic- 19 ipating entity through which the insurer offers health services shall 20 not: 21 (i) vary the terms of the policy for the purpose or with the effect of 22 avoiding compliance with this paragraph; 23 (ii) provide incentives (monetary or otherwise) to encourage a covered 24 person to accept less than the minimum protections available under this 25 paragraph; EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD13718-01-1 S. 6055 2 1 (iii) penalize in any way or reduce or limit the compensation of a 2 health care practitioner for recommending or providing care to a covered 3 person in accordance with this paragraph; 4 (iv) provide incentives (monetary or otherwise) to a health care prac- 5 titioner relating to the services provided pursuant to this paragraph 6 intended to induce or have the effect of inducing such practitioner to 7 provide care to a covered person in a manner inconsistent with this 8 paragraph; or 9 (v) achieve compliance with this paragraph by imposing an increase in 10 cost sharing for an intravenous or injected anticancer medication. 11 S 2. Paragraph 12-a of subsection (1) of section 3221 of the insurance 12 law, as added by chapter 559 of the laws of 2011, is amended to read as 13 follows: 14 (12-a) (A) Every policy delivered or issued for delivery in this state 15 that provides medical, major medical, or similar comprehensive-type 16 coverage and provides coverage for prescription drugs and also provides 17 coverage for cancer chemotherapy treatment shall provide coverage for 18 [a] prescribed, orally administered anticancer [medication] MEDICATIONS 19 used to kill or slow the growth of cancerous cells [and shall apply the 20 lower cost sharing of either (i) anticancer medication under the 21 prescription drug benefit or (ii)]. SUCH COVERAGE MAY BE SUBJECT TO 22 CO-PAYS, COINSURANCE OR DEDUCTIBLES, PROVIDED THAT THE CO-PAYS, COINSU- 23 RANCE OR DEDUCTIBLES ARE AT LEAST AS FAVORABLE TO AN INSURED AS THE 24 CO-PAYS, COINSURANCE OR DEDUCTIBLES THAT APPLY TO COVERAGE FOR intrave- 25 nous or injected anticancer medications. [For the purposes of this 26 section "cost sharing" shall include co-pays, coinsurance, and deduct- 27 ibles as deemed appropriate by the superintendent.] 28 (B) An insurer providing coverage under this paragraph and any partic- 29 ipating entity through which the insurer offers health services shall 30 not: 31 (i) vary the terms of the policy for the purpose or with the effect of 32 avoiding compliance with this paragraph; 33 (ii) provide incentives (monetary or otherwise) to encourage a covered 34 person to accept less than the minimum protections available under this 35 paragraph; 36 (iii) penalize in any way or reduce or limit the compensation of a 37 health care practitioner for recommending or providing care to a covered 38 person in accordance with this paragraph; 39 (iv) provide incentives (monetary or otherwise) to a health care prac- 40 titioner relating to the services provided pursuant to this paragraph 41 intended to induce or have the effect of inducing such practitioner to 42 provide care to a covered person in a manner inconsistent with this 43 paragraph; or 44 (v) achieve compliance with this paragraph by imposing an increase in 45 cost sharing for an intravenous or injected anticancer medication. 46 S 3. Subsection (q-1) of section 4303 of the insurance law, as added 47 by chapter 559 of the laws of 2011, is amended to read as follows: 48 (q-1) (1) Every [policy] CONTRACT issued by a medical expense indem- 49 nity corporation, a hospital service corporation or a health service 50 corporation for delivery in this state that provides medical, major 51 medical or similar comprehensive-type coverage and provides coverage for 52 prescription drugs and for cancer chemotherapy treatment shall provide 53 coverage for [a] prescribed, orally administered anticancer [medication] 54 MEDICATIONS used to kill or slow the growth of cancerous cells [and 55 shall apply the lower cost sharing of either (A) anticancer medication 56 under the prescription drug benefit or (B)]. SUCH COVERAGE MAY BE S. 6055 3 1 SUBJECT TO CO-PAYS, COINSURANCE OR DEDUCTIBLES, PROVIDED THAT THE 2 CO-PAYS, COINSURANCE OR DEDUCTIBLES ARE AT LEAST AS FAVORABLE TO AN 3 INSURED AS THE CO-PAYS, COINSURANCE OR DEDUCTIBLES THAT APPLY TO COVER- 4 AGE FOR intravenous or injected anticancer medications. [For the 5 purposes of this section "cost sharing" shall include co-payments, coin- 6 surance, and deductibles as deemed appropriate by the superintendent.] 7 (2) An insurer providing coverage under this paragraph and any partic- 8 ipating entity through which the insurer offers health services shall 9 not: 10 (A) vary the terms of the [policy] CONTRACT for the purpose or with 11 the effect of avoiding compliance with this paragraph; 12 (B) provide incentives (monetary or otherwise) to encourage a covered 13 person to accept less than the minimum protections available under this 14 paragraph; 15 (C) penalize in any way or reduce or limit the compensation of a 16 health care practitioner for recommending or providing care to a covered 17 person in accordance with this paragraph; 18 (D) provide incentives (monetary or otherwise) to a health care prac- 19 titioner relating to the services provided pursuant to this paragraph 20 intended to induce or have the effect of inducing such practitioner to 21 provide care to a covered person in a manner inconsistent with this 22 paragraph; or 23 (E) achieve compliance with this paragraph by imposing an increase in 24 cost sharing for an intravenous or injected anticancer medication. 25 S 4. This act shall take effect on the same date and in the same 26 manner as chapter 559 of the laws of 2011, takes effect.