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S.B. 189





Chief Sponsor: Curtis S. Bramble

House Sponsor: Ronda Rudd Menlove

             7      LONG TITLE
             8      General Description:
             9          This bill amends Part 6, Accident and Health Insurance, in Chapter 22, Contracts in
             10      Specific Lines, of the Insurance Code.
             11      Highlighted Provisions:
             12          This bill:
             13          .    defines terms; and
             14          .    provides that if a health insurer covers both oral chemotherapy and intravenous
             15      chemotherapy, the insurer may not impose more restrictive cost sharing and treatment limits on
             16      the oral chemotherapy than those imposed on the intravenous chemotherapy.
             17      Money Appropriated in this Bill:
             18          None
             19      Other Special Clauses:
             20          None
             21      Utah Code Sections Affected:
             22      ENACTS:
             23          31A-22-641, Utah Code Annotated 1953
             25      Be it enacted by the Legislature of the state of Utah:
             26          Section 1. Section 31A-22-641 is enacted to read:
             27          31A-22-641. Cancer treatment parity.

             28          (1) For purposes of this section:
             29          (a) "Cost sharing" includes copayments, deductibles, coinsurance, and other dollar
             30      limits.
             31          (b) "Health insurer" is as defined in Subsection 31A-22-634 (1).
             32          (c) "Intravenously administered chemotherapy" means a physician-prescribed cancer
             33      treatment that is administered through injection directly into the patient's circulatory system by
             34      a physician, physician assistant, nurse practitioner, nurse, or other medical personnel under the
             35      supervision of a physician and in a hospital, medical office, or other clinical setting.
             36          (d) "Oral chemotherapy" means a U.S. Food and Drug Administration-approved,
             37      physician-prescribed cancer treatment that is taken orally in the form of a tablet or capsule and
             38      may be administered in a hospital, medical office, or other clinical setting or may be delivered
             39      to the patient for self-administration under the direction or supervision of a physician outside of
             40      a hospital, medical office, or other clinical setting.
             41          (2) This section applies to health benefit plans renewed or entered into on or after July
             42      1, 2013.
             43          (3) A health benefit plan that covers prescribed oral chemotherapy and intravenously
             44      administered chemotherapy shall ensure that the cost sharing and treatment limitations
             45      applicable to the covered oral chemotherapy are no more restrictive than the cost sharing and
             46      treatment limitations applied to the covered intravenously administered chemotherapy.
             47          (4) (a) A health insurer shall not increase the cost sharing for intravenously
             48      administered chemotherapy for the purpose of achieving compliance with this section.
             49          (b) The commissioner may adopt administrative rules in accordance with Title 63G,
             50      Chapter 3, Utah Administrative Rulemaking Act, to enforce the provisions of this section.

Legislative Review Note
    as of 2-12-13 9:27 AM

Office of Legislative Research and General Counsel

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