STATE OF NEW YORK
________________________________________________________________________
6233--B
2011-2012 Regular Sessions
IN ASSEMBLY
March 10, 2011
___________
Introduced by M. of A. V. LOPEZ, SCHROEDER, KELLNER, GUNTHER, COLTON,
TITONE, SPANO, ROSENTHAL, JAFFEE, GIBSON, CASTRO, N. RIVERA, LAVINE,
PERRY, BRONSON, ABINANTI, HEVESI, ENGLEBRIGHT, DINOWITZ, DenDEKKER,
CYMBROWITZ, MAISEL, M. MILLER, GOTTFRIED, BENEDETTO, P. RIVERA, SCAR-
BOROUGH, REILLY, ROBERTS, PEOPLES-STOKES, SCHIMMINGER, WEPRIN, MOYA,
HOOPER, MILLMAN, MURRAY -- Multi-Sponsored by -- M. of A. ABBATE,
BARRON, BING, BOYLAND, BRENNAN, BURLING, CAHILL, CALHOUN, CERETTO,
COOK, CRESPO, CROUCH, GABRYSZAK, GALEF, GLICK, JACOBS, JOHNS, JORDAN,
LANCMAN, LATIMER, LIFTON, LOSQUADRO, LUPARDO, MAGEE, MARKEY, McENENY,
McKEVITT, McLAUGHLIN, MENG, J. MILLER, MONTESANO, NOLAN, PAULIN, PRET-
LOW, RAIA, RUSSELL, SCHIMEL, SWEENEY, WEISENBERG -- read once and
referred to the Committee on Insurance -- committee discharged, bill
amended, ordered reprinted as amended and recommitted to said commit-
tee -- again reported from said committee with amendments, ordered
reprinted as amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to policy coverage of
chemotherapy treatment
The People of the State of New York, represented in Senate and Assem-bly, do enact as follows:
1 Section 1. Legislative findings. The legislature finds that advances
2 in medical research have led to significant new developments of various
3 medical treatments. These treatments offer patients a wide range of new
4 choices to combat very serious diseases. The area of cancer treatment
5 has been one of the fields that has seen these significant new medical
6 advancements. In recent years, oral chemotherapy treatments have been
7 developed that provide viable alternatives to traditional intravenous
8 cancer treatments for patients. This oral chemotherapy treatment offers
9 the treating physician and the patient a choice in relation to treatment
10 options. However, this choice is sometimes limited as the oral chemoth-
11 erapy treatments are, in most cases, covered under the prescription drug
12 benefit of an insurance plan rather than under the major medical insur-
EXPLANATION--Matter in italics (underscored) is new; matter in brackets
[] is old law to be omitted.
LBD09290-05-1
A. 6233--B 2
1 ance benefit of an insurance plan. This discrepancy in coverage can
2 limit a patient's ability to choose the oral chemotherapy treatment
3 because of the cost associated with the disparate treatment.
4 § 2. Subsection (i) of section 3216 of the insurance law is amended by
5 adding a new paragraph 12-a to read as follows:
6 (12-a) (A) Every policy delivered or issued for delivery in this state
7 that provides medical, major medical, or similar comprehensive-type
8 coverage and provides coverage for prescription drugs and also provide
9 coverage for cancer chemotherapy treatment shall provide coverage for a
10 prescribed, orally administered anticancer medication used to kill or
11 slow the growth of cancerous cells and shall apply the lower cost shar-
12 ing of either (i) anticancer medication under the prescription drug
13 benefit or (ii) intravenous or injected anticancer medications. For the
14 purposes of this section "cost sharing" shall include co-pays, coinsu-
15 rance, and deductibles as deemed appropriate by the superintendent.
16 (B) An insurer providing coverage under this paragraph and any partic-
17 ipating entity through which the insurer offers health services shall
18 not:
19 (i) vary the terms of the policy for the purpose or with the effect of
20 avoiding compliance with this paragraph;
21 (ii) provide incentives (monetary or otherwise) to encourage a covered
22 person to accept less than the minimum protections available under this
23 paragraph;
24 (iii) penalize in any way or reduce or limit the compensation of a
25 health care practitioner for recommending or providing care to a covered
26 person in accordance with this paragraph;
27 (iv) provide incentives (monetary or otherwise) to a health care prac-
28 titioner relating to the services provided pursuant to this paragraph
29 intended to induce or have the effect of inducing such practitioner to
30 provide care to a covered person in a manner inconsistent with this
31 paragraph; or
32 (v) achieve compliance with this paragraph by imposing an increase in
33 cost sharing for an intravenous or injected anticancer medication.
34 § 3. Subsection (l) of section 3221 of the insurance law is amended by
35 adding a new paragraph 12-a to read as follows:
36 (12-a) (A) Every policy delivered or issued for delivery in this state
37 that provides medical, major medical, or similar comprehensive-type
38 coverage and provides coverage for prescription drugs and also provides
39 coverage for cancer chemotherapy treatment shall provide coverage for a
40 prescribed, orally administered anticancer medication used to kill or
41 slow the growth of cancerous cells and shall apply the lower cost shar-
42 ing of either (i) anticancer medication under the prescription drug
43 benefit or (ii) intravenous or injected anticancer medications. For the
44 purposes of this section "cost sharing" shall include co-pays, coinsu-
45 rance, and deductibles as deemed appropriate by the superintendent.
46 (B) An insurer providing coverage under this paragraph and any partic-
47 ipating entity through which the insurer offers health services shall
48 not:
49 (i) vary the terms of the policy for the purpose or with the effect of
50 avoiding compliance with this paragraph;
51 (ii) provide incentives (monetary or otherwise) to encourage a covered
52 person to accept less than the minimum protections available under this
53 paragraph;
54 (iii) penalize in any way or reduce or limit the compensation of a
55 health care practitioner for recommending or providing care to a covered
56 person in accordance with this paragraph;
A. 6233--B 3
1 (iv) provide incentives (monetary or otherwise) to a health care prac-
2 titioner relating to the services provided pursuant to this paragraph
3 intended to induce or have the effect of inducing such practitioner to
4 provide care to a covered person in a manner inconsistent with this
5 paragraph; or
6 (v) achieve compliance with this paragraph by imposing an increase in
7 cost sharing for an intravenous or injected anticancer medication.
8 § 4. Section 4303 of the insurance law is amended by adding a new
9 subsection (q-l) to read as follows:
10 (q-1) (1) Every policy issued by a medical expense indemnity corpo-
11 ration, a hospital service corporation or a health service corporation
12 for delivery in this state that provides medical, major medical or simi-
13 lar comprehensive-type coverage and provides coverage for prescription
14 drugs and for cancer chemotherapy treatment shall provide coverage for a
15 prescribed, orally administered anticancer medication used to kill or
16 slow the growth of cancerous cells and shall apply the lower cost shar-
17 ing of either (A) anticancer medication under the prescription drug
18 benefit or (B) intravenous or injected anticancer medications. For the
19 purposes of this section "cost sharing" shall include co-payments, coin-
20 surance, and deductibles as deemed appropriate by the superintendent.
21 (2) An insurer providing coverage under this paragraph and any partic-
22 ipating entity through which the insurer offers health services shall
23 not:
24 (A) vary the terms of the policy for the purpose or with the effect of
25 avoiding compliance with this paragraph;
26 (B) provide incentives (monetary or otherwise) to encourage a covered
27 person to accept less than the minimum protections available under this
28 paragraph;
29 (C) penalize in any way or reduce or limit the compensation of a
30 health care practitioner for recommending or providing care to a covered
31 person in accordance with this paragraph;
32 (D) provide incentives (monetary or otherwise) to a health care prac-
33 titioner relating to the services provided pursuant to this paragraph
34 intended to induce or have the effect of inducing such practitioner to
35 provide care to a covered person in a manner inconsistent with this
36 paragraph; or
37 (E) achieve compliance with this paragraph by imposing an increase in
38 cost sharing for an intravenous or injected anticancer medication.
39 § 5. This act shall take effect on the first of January next succeed-
40 ing the date on which it shall have become a law and shall apply to all
41 policies and contracts issued, renewed, modified, altered or amended on
42 or after such effective date.
