First Substitute S.B. 189

Senator Curtis S. Bramble proposes the following substitute bill:

1 ONCOLOGY INSURANCE AMENDMENTS
2 2013 GENERAL SESSION
3 STATE OF UTAH
4 Chief Sponsor: Curtis S. Bramble
5 House Sponsor: Brad R. Wilson
6
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 anticancer medication, the insurer may not
15 exceed certain cost sharing limits.
16 Money Appropriated in this Bill:
17 None
18 Other Special Clauses:
19 None
20 Utah Code Sections Affected:
21 ENACTS:
22 31A-22-641, Utah Code Annotated 1953
23
24 Be it enacted by the Legislature of the state of Utah:
25 Section 1. Section 31A-22-641 is enacted to read:

26 31A-22-641. Cancer treatment parity.
27 (1) For purposes of this section:
28 (a) "Anticancer medication" means prescribed, self administered anticancer medication
29 that is used to kill or slow the growth of cancerous cells.
30 (b) "Cost sharing" includes copayments, deductibles, coinsurance, and other dollar
31 limits.
32 (c) "Health insurer" is as defined in Subsection 31A-22-634 (1).
33 (2) This section applies to health benefit plans renewed or entered into on or after July
34 1, 2013.
35 (3) A health benefit plan that covers anticancer medication:
36 (a) shall not impose a copayment or coinsurance that exceeds $250 a month for the
37 anticancer medication; and
38 (b) shall apply any monthly out-of-pocket costs for the anticancer medication that is
39 paid by the individual to any deductibles or maximum out-of-pocket costs imposed by the
40 health benefit plan.
41 (4) (a) A health insurer shall not increase the cost sharing for anticancer medication or
42 other physician prescribed cancer treatment, however administered, for the purpose of
43 achieving compliance with this section.
44 (b) The commissioner may adopt administrative rules in accordance with Title 63G,
45 Chapter 3, Utah Administrative Rulemaking Act, to enforce the provisions of this section.

[Bill Documents]