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Second Substitute S.B. 189

This document includes Senate 2nd and 3rd Reading Floor Amendments incorporated into the bill on Wed, Mar 13, 2013 at 6:47 PM by lpoole. --> This document includes Senate 2nd and 3rd Reading Floor Amendments incorporated into the bill on Wed, Mar 13, 2013 at 6:55 PM by lpoole. -->

Representative Brad R. Wilson 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 the Accident and Health Insurance part of the Contracts in Specific
             10      Lines chapter of the Insurance Code.
             11      Highlighted Provisions:
             12          This bill:
             13          .    defines terms;
             14          .    provides that if a health insurer covers both oral chemotherapy and intravenous
             15      chemotherapy, the insurer:
             16              .    shall apply the same cost sharing requirements to both oral chemotherapy and
             17      intravenous chemotherapy; or
             18              .    shall not impose a cost sharing for oral chemotherapy that exceeds $300, if the
             19      insurer imposes different cost sharing for oral chemotherapy and intravenous
             20      chemotherapy;
             21          .    prohibits a health insurer from increasing the cost sharing for oral or intravenous
             22      chemotherapy for the purpose of achieving compliance with this section;
             23          .    gives the Insurance Department administrative rulemaking authority; and
             24          .    provides a private right of action.
             25      Money Appropriated in this Bill:



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             26
         None
             27      Other Special Clauses:
             28          None
             29      Utah Code Sections Affected:
             30      ENACTS:
             31          31A-22-641, Utah Code Annotated 1953
             32     

             33      Be it enacted by the Legislature of the state of Utah:
             34          Section 1. Section 31A-22-641 is enacted to read:
             35          31A-22-641. Cancer treatment parity.
             36          (1) For purposes of this section:
             37          (a) "Cost sharing" means the enrollee's maximum out-of-pocket costs as defined by the
             38      health benefit plan.
             39          (b) "Health insurer" is as defined in Subsection 31A-22-634 (1).
             40          (c) "Intravenously administered chemotherapy" means a physician-prescribed cancer
             41      treatment that is used to kill or slow the growth of cancer cells, that is administered through
             42      injection directly into the patient's circulatory system by a physician, physician assistant, nurse
             43      practitioner, nurse, or other medical personnel under the supervision of a physician, and in a
             44      hospital, medical office, or other clinical setting.
             45          (d) "Oral chemotherapy" means a United States Food and Drug
             46      Administration-approved, physician-prescribed cancer treatment that is used to kill or slow the
             47      growth of cancer cells, that is taken orally in the form of a tablet or capsule, and may be
             48      administered in a hospital, medical office, or other clinical setting or may be delivered to the
             49      patient for self-administration under the direction or supervision of a physician outside of a
             50      hospital, medical office, or other clinical setting.
             51          (2) This section applies to health benefit plans renewed or entered into on or after
             52      October 1, 2013.
             53          (3) A health benefit plan that covers prescribed oral chemotherapy and intravenously
             54      administered chemotherapy shall:
             55          (a) except as provided in Subsection (3)(b), ensure that the cost sharing applied to the
             56      covered oral chemotherapy is no more restrictive than the cost sharing applied to the covered



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             57      intravenously administered chemotherapy; or
             58          (b) if the cost sharing for oral chemotherapy is more restrictive than the cost sharing for
             59      intravenous chemotherapy, the health benefit plan may not apply cost sharing for the oral
             60      chemotherapy that exceeds $300 per filled prescription.
             61          (4) (a) A health insurer shall not increase the cost sharing for intravenously
             62      administered chemotherapy for the purpose of achieving compliance with this section.
             63          (b) The commissioner may adopt administrative rules in accordance with Title 63G,
             64      Chapter 3, Utah Administrative Rulemaking Act, to enforce the provisions of this section.
             65           (c) A person who is injured by a violation of this section has a private right of action
             66      against the insurer who violated the provisions of this section for damages proximately caused
             67      by the violation.


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