S T A T E O F N E W Y O R K
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10219--A
I N A S S E M B L Y
March 11, 2010
___________
Introduced by M. of A. JACOBS -- read once and referred to the Committee
on Insurance -- committee discharged, bill amended, ordered reprinted
as amended and recommitted to said committee
AN ACT to amend the insurance law, in relation to insurance coverage for
drugs used in cancer treatment
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. Paragraph 12 of subsection (i) of section 3216 of the
insurance law, as added by chapter 853 of the laws of 1990, is amended
to read as follows:
(12) (A) Every policy which provides coverage for prescribed drugs
approved by the food and drug administration of the United States
government for the treatment of certain types of cancer shall not
exclude coverage of any such drug on the basis that such drug has been
prescribed for the treatment of a type of cancer for which the drug has
not been approved by the food and drug administration. Provided, howev-
er, that such drug must be recognized for treatment of the specific type
of cancer for which the drug has been prescribed in one of the following
established reference compendia:
[(i) the American Medical Association Drug Evaluations;
(ii) the American Hospital Formulary Service Drug Information; or
(iii) the United States Pharmacopeia Drug Information; or recommended
by review article or editorial comment in a major peer reviewed profes-
sional journal.]
(I) THE AMERICAN HOSPITAL FORMULARY SERVICE-DRUG INFORMATION (AHFS-
DI);
(II) NATIONAL COMPREHENSIVE CANCER NETWORKS DRUGS AND BIOLOGICS
COMPENDIUM;
(III) THOMSON MICROMEDEX DRUGDEX;
(IV) ELSEVIER GOLD STANDARD'S CLINICAL PHARMACOLOGY; OR OTHER AUTHORI-
TATIVE COMPENDIA AS IDENTIFIED BY THE FEDERAL SECRETARY OF HEALTH AND
HUMAN SERVICES OR THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS); OR
RECOMMENDED BY REVIEW ARTICLE OR EDITORIAL COMMENT IN A MAJOR PEER
REVIEWED PROFESSIONAL JOURNAL.
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD16275-04-0
A. 10219--A 2
(B) Notwithstanding the provisions of this paragraph, coverage shall
not be required for any experimental or investigational drugs or any
drug which the food and drug administration has determined to be
contraindicated for treatment of the specific type of cancer for which
the drug has been prescribed. The provisions of this paragraph shall
apply to cancer drugs only and nothing herein shall be construed to
create, impair, alter, limit, modify, enlarge, abrogate or prohibit
reimbursement for drugs used in the treatment of any other disease or
condition.
S 2. Paragraph 12 of subsection (1) of section 3221 of the insurance
law, as added by chapter 853 of the laws of 1990, is amended to read as
follows:
(12) (A) Every insurer delivering a group or blanket policy or issuing
a group or blanket policy for delivery in this state which provides
coverage for prescribed drugs approved by the food and drug adminis-
tration of the United States government for the treatment of certain
types of cancer shall not exclude coverage of any such drug on the basis
that such drug has been prescribed for the treatment of a type of cancer
for which the drug has not been approved by the food and drug adminis-
tration. Provided, however, that such drug must be recognized for treat-
ment of the specific type of cancer for which the drug has been
prescribed in one of the following established reference compendia:
[(i) the American Medical Association Drug Evaluations;
(ii) the American Hospital Formulary Service Drug Information; or
(iii) the United States Pharmacopeia Drug Information; or recommended
by review article or editorial comment in a major peer reviewed profes-
sional journal.]
(I) THE AMERICAN HOSPITAL FORMULARY SERVICE-DRUG INFORMATION (AHFS-
DI);
(II) NATIONAL COMPREHENSIVE CANCER NETWORKS DRUGS AND BIOLOGICS
COMPENDIUM;
(III) THOMSON MICROMEDEX DRUGDEX;
(IV) ELSEVIER GOLD STANDARD'S CLINICAL PHARMACOLOGY; OR OTHER AUTHORI-
TATIVE COMPENDIA AS IDENTIFIED BY THE FEDERAL SECRETARY OF HEALTH AND
HUMAN SERVICES OR THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS); OR
RECOMMENDED BY REVIEW ARTICLE OR EDITORIAL COMMENT IN A MAJOR PEER
REVIEWED PROFESSIONAL JOURNAL.
(B) Notwithstanding the provisions of this paragraph, coverage shall
not be required for any experimental or investigational drugs or any
drug which the food and drug administration has determined to be
contraindicated for treatment of the specific type of cancer for which
the drug has been prescribed. The provisions of this paragraph shall
apply to cancer drugs only and nothing herein shall be construed to
create, impair, alter, limit, modify, enlarge, abrogate or prohibit
reimbursement for drugs used in the treatment of any other disease or
condition.
S 3. Subsection (q) of section 4303 of the insurance law, as added by
chapter 853 of the laws of 1990, is amended to read as follows:
(q) (1) Every policy issued by a medical expense indemnity corpo-
ration, a hospital service corporation or a health service corporation
which provides coverage for prescribed drugs approved by the food and
drug administration of the United States government for the treatment of
certain types of cancer shall not exclude coverage of any such drug on
the basis that such drug has been prescribed for the treatment of a type
of cancer for which the drug has not been approved by the food and drug
administration. Provided, however, that such drug must be recognized for
A. 10219--A 3
treatment of the specific type of cancer for which the drug has been
prescribed in one of the following established reference compendia:
[(i) the American Medical Association Drug Evaluations;
(ii) the American Hospital Formulary Service Drug Information; or
(iii) the United States Pharmacopeia Drug Information; or recommended
by review article or editorial comment in a major peer reviewed profes-
sional journal.]
(I) THE AMERICAN HOSPITAL FORMULARY SERVICE-DRUG INFORMATION (AHFS-
DI);
(II) NATIONAL COMPREHENSIVE CANCER NETWORKS DRUGS AND BIOLOGICS
COMPENDIUM;
(III) THOMSON MICROMEDEX DRUGDEX;
(IV) ELSEVIER GOLD STANDARD'S CLINICAL PHARMACOLOGY; OR OTHER AUTHORI-
TATIVE COMPENDIA AS IDENTIFIED BY THE FEDERAL SECRETARY OF HEALTH AND
HUMAN SERVICES OR THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS); OR
RECOMMENDED BY REVIEW ARTICLE OR EDITORIAL COMMENT IN A MAJOR PEER
REVIEWED PROFESSIONAL JOURNAL.
(2) Notwithstanding the provisions of this subsection, coverage shall
not be required for any experimental or investigational drugs or any
drug which the food and drug administration has determined to be
contraindicated for treatment of the specific type of cancer for which
the drug has been prescribed. The provisions of this subsection shall
apply to cancer drugs only and nothing herein shall be construed to
create, impair, alter, limit, modify, enlarge, abrogate or prohibit
reimbursement for drugs used in the treatment of any other disease or
condition.
S 4. Subsection (g-5) of section 4900 of the insurance law, as added
by chapter 586 of the laws of 1998, is amended to read as follows:
(g-5) "Medical and scientific evidence" means the following sources:
(1) peer-reviewed scientific studies published in, or accepted for
publication by, medical journals that meet nationally recognized
requirements for scientific manuscripts and that submit most of their
published articles for review by experts who are not part of the edito-
rial staff;
(2) peer-reviewed medical literature, including literature relating to
therapies reviewed and approved by a qualified institutional review
board, biomedical compendia and other medical literature that meet the
criteria of the National Institute of Health's National Library of Medi-
cine for indexing in Index Medicus, Excerpta Medicus, Medline and
MEDLARS database Health Services Technology Assessment Research;
(3) peer-reviewed abstracts accepted for presentation at major medical
association meetings;
(4) peer-reviewed literature shall not include publications or supple-
ments to publications sponsored to a significant extent by a pharmaceu-
tical manufacturing company or medical device manufacturer;
(5) medical journals recognized by the secretary of Health and Human
Services, under section 1861 (t)(2) of the federal Social Security Act;
(6) the following standard reference compendia:
(A) the American Hospital Formulary Service - Drug Information;
(B) [the American Medical Association Drug Evaluation;] THE NATIONAL
COMPREHENSIVE CANCER NETWORK'S DRUGS AND BIOLOGICS COMPENDIUM;
(C) the American Dental Association Accepted Dental Therapeutics; [and
(D) the United States Pharmacopeia - Drug Information;] (D) THOMSON
MICROMEDEX DRUGDEX;
(E) ELSEVIER GOLD STANDARD'S CLINICAL PHARMACOLOGY; OR OTHER AUTHORI-
TATIVE COMPENDIA AS IDENTIFIED BY THE FEDERAL SECRETARY OF HEALTH AND
A. 10219--A 4
HUMAN SERVICES OR THE CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS); OR
RECOMMENDED BY REVIEW ARTICLE OR EDITORIAL COMMENT IN A MAJOR PEER
REVIEWED PROFESSIONAL JOURNAL;
(7) findings, studies, or research conducted by or under the auspices
of federal government agencies and nationally recognized federal
research institutes including the federal Agency for Health Care Policy
and Research, National Institutes of Health, National Cancer Institute,
National Academy of Sciences, Health Care Financing Administration,
Congressional Office of Technology Assessment, and any national board
recognized by the National Institutes of Health for the purpose of eval-
uating the medical value of health services.
S 5. This act shall take effect on the first of January next succeed-
ing the date on which it shall have become a law, and shall apply to all
policies and contracts issued, renewed, modified, altered or amended on
or after such effective date.