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S.B. 189 Enrolled

             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; and
             23          .    gives the Insurance Department administrative rulemaking authority.
             24      Money Appropriated in this Bill:
             25          None
             26      Other Special Clauses:
             27          None
             28      Utah Code Sections Affected:
             29      ENACTS:


             30          31A-22-641, Utah Code Annotated 1953
             31     
             32      Be it enacted by the Legislature of the state of Utah:
             33          Section 1. Section 31A-22-641 is enacted to read:
             34          31A-22-641. Cancer treatment parity.
             35          (1) For purposes of this section:
             36          (a) "Cost sharing" means the enrollee's maximum out-of-pocket costs as defined by the
             37      health benefit plan.
             38          (b) "Health insurer" is as defined in Subsection 31A-22-634 (1).
             39          (c) "Intravenously administered chemotherapy" means a physician-prescribed cancer
             40      treatment that is used to kill or slow the growth of cancer cells, that is administered through
             41      injection directly into the patient's circulatory system by a physician, physician assistant, nurse
             42      practitioner, nurse, or other medical personnel under the supervision of a physician, and in a
             43      hospital, medical office, or other clinical setting.
             44          (d) "Oral chemotherapy" means a United States Food and Drug
             45      Administration-approved, physician-prescribed cancer treatment that is used to kill or slow the
             46      growth of cancer cells, that is taken orally in the form of a tablet or capsule, and may be
             47      administered in a hospital, medical office, or other clinical setting or may be delivered to the
             48      patient for self-administration under the direction or supervision of a physician outside of a
             49      hospital, medical office, or other clinical setting.
             50          (2) This section applies to health benefit plans renewed or entered into on or after
             51      October 1, 2013.
             52          (3) A health benefit plan that covers prescribed oral chemotherapy and intravenously
             53      administered chemotherapy shall:
             54          (a) except as provided in Subsection (3)(b), ensure that the cost sharing applied to the
             55      covered oral chemotherapy is no more restrictive than the cost sharing applied to the covered
             56      intravenously administered chemotherapy; or
             57          (b) if the cost sharing for oral chemotherapy is more restrictive than the cost sharing for


             58      intravenous chemotherapy, the health benefit plan may not apply cost sharing for the oral
             59      chemotherapy that exceeds $300 per filled prescription.
             60          (4) (a) A health insurer shall not increase the cost sharing for intravenously
             61      administered chemotherapy for the purpose of achieving compliance with this section.
             62          (b) The commissioner may adopt administrative rules in accordance with Title 63G,
             63      Chapter 3, Utah Administrative Rulemaking Act, to enforce the provisions of this section.


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