HB86 By Representative Johnson (R) RFD Insurance Rd 1 03-FEB-16

SYNOPSIS: This bill would prohibit a state regulated health benefit plan that covers intravenously administered, or injected anticancer therapies and orally administered anticancer therapies from requiring the insured to pay a higher copayment, deductible, or coinsurance amount for a patient-administered anticancer medication than is required for an anticancer medication that is injected or otherwise administered intravenously by a health care provider, regardless of the formulation or benefit category determination of the medication in the health benefit plan.

This bill would also prohibit a health insurance plan from circumventing this prohibition by increasing the copayment, deductible, or coinsurance amount for an intravenous or injected chemotherapy drug that is covered under the health insurance plan or by reclassifying the anticancer benefits under the plan.

A BILL TO BE ENTITLED AN ACT

Relating to insurance; to prohibit a state regulated health benefit plan that covers intravenously administered, or injected anticancer therapies and orally administered anticancer therapies from requiring the insured to pay a higher copayment, deductible, or coinsurance amount for an anticancer medication that is patient-administered than is required for an anticancer medication that is injected or otherwise administered intravenously by a health care provider, regardless of the formulation or benefit category determination of the medication in the health benefit plan; and to prohibit a health insurance plan from circumventing this prohibition by increasing the copayment, deductible, or coinsurance amount for an intravenous or injected chemotherapy drug that is covered under the health insurance plan or by reclassifying the anticancer benefits under the plan.

BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:

Section 1. (a) For purposes of this section, the following terms have the following meanings:

(1) ANTICANCER MEDICATION. A drug or biologic used to kill, slow, or prevent the growth of cancerous cells.

(2) HEALTH BENEFIT PLAN. An individual or group insurance plan, policy, or contract for health care services that covers hospital, medical, surgical expenses, or prescription drug benefits, health maintenance organizations, preferred provider organizations, medical service organizations, physician-hospital organizations, or any other person, firm, corporation, joint venture, or other similar business entity that pays for, purchases, or furnishes individual or group health care services to patients, insureds, or beneficiaries in this state. For the purposes of this section, a health benefit plan located or domiciled outside of the State of Alabama is deemed to be subject to this section if the plan, policy, or contract is issued or delivered in the State of Alabama. The term includes, but is not limited to, entities created pursuant to Article 6, Chapter 20, Title 10A of the Code of Alabama 1975. The term does not include accident-only, specified disease, individual hospital indemnity, credit, dental-only, Medicare-supplement, long-term care, or disability income insurance, other limited benefit health insurance policies, coverage issued as a supplemental to liability insurance, workers' compensation or similar insurance, or automobile medical-payment insurance.

(b) A health benefit plan that covers anticancer medications that are injected or intravenously administered by a health care provider or a patient-administered anticancer medication, including, but not limited to, those medications orally administered or self-injected, may not require a higher copayment, deductible, or coinsurance amount for a patient administered anticancer medications than it requires for anticancer medications injected or intravenously administered by a health care provider, regardless of the formulation or benefit category specified in the health benefit plan.

(c) A health benefit plan may not comply with subsection (b) by doing either of the following:

(1) Increasing the copayment, deductible, or coinsurance amount required for injected or intravenously administered anticancer medications that are covered by the health benefit plan.

(2) Reclassifying benefits provided by the health benefit plan with respect to anticancer medications.

Section 2. This act shall become effective on the first day of the third month following its passage and approval by the Governor, or its otherwise becoming law.

Health

Health Benefit Plans

Insurance

Cancer

Health Care Providers

Prescription Drugs