STATE OF OKLAHOMA

1st Session of the 54th Legislature (2013)

HOUSE BILL 2202	By:	Derby

AS INTRODUCED

An Act relating to insurance; requiring health benefit plans to provide coverage for oral anticancer medications on certain basis; prohibiting increase in certain out-of-pocket expenses; providing for interpretation; defining terms; and providing an effective date.

BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 6060.9a of Title 36, unless there is created a duplication in numbering, reads as follows:
A.  1.  Any health benefit plan that provides coverage and benefits for cancer treatment shall provide coverage of prescribed orally administered anticancer medications on a basis no less favorable than intravenously administered or injected cancer medications;
2.  Coverage of orally administered anticancer medications shall not be subject to any prior authorization, dollar limit, copayment, deductible, or other out-of-pocket expense that does not apply to intravenously administered or injected cancer medications, regardless of formulation or benefit category determination by the company administering the health benefit plan;
3.  A health benefit plan shall not reclassify or increase any type of cost-sharing to the covered person for anticancer medications in order to achieve compliance with this section.  Any change in health insurance coverage that otherwise increases an out-of-pocket expense applied to anticancer medications shall also be applied to the majority of comparable medical or pharmaceutical benefits covered by the health benefit plan; and 
4.  A health benefit plan that limits the total amount paid by a covered person through all cost-sharing requirements to no more than One Hundred Dollars ($100.00) per filled prescription for any orally administered anticancer medication shall be considered in compliance with this section.  For purposes of this paragraph, “cost-sharing requirements” shall include copayments, coinsurance, deductibles, and any other amounts paid by the covered person for that prescription.
B.  As used in this section:
1.  “Anticancer medications” mean medications used to kill or slow the growth of cancer cells;
2.  “Covered person” means a policyholder, subscriber, enrollee, or other individual enrolled in or insured by a health benefit plan for health insurance coverage; and
3.  “Health benefit plan” means any plan or arrangement as defined in subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes.
SECTION 2.  This act shall become effective November 1,2013.

54-1-6595	AMM	01/15/13