S T A T E O F N E W Y O R K
________________________________________________________________________
7355--B
2009-2010 Regular Sessions
I N A S S E M B L Y
March 31, 2009
___________
Introduced by M. of A. V. LOPEZ, SCHROEDER, KELLNER, GUNTHER, COLTON,
O'DONNELL, TITONE, STIRPE, PHEFFER, SPANO, ROSENTHAL, JAFFEE, GIBSON,
CASTRO, N. RIVERA, POWELL, LAVINE, PERRY -- Multi-Sponsored by -- M.
of A. ALESSI, BARRON, BING, BRENNAN, CAHILL, CRESPO, CYMBROWITZ,
FIELDS, GABRYSZAK, GALEF, GLICK, HOOPER, HYER-SPENCER, JACOBS, KOON,
LANCMAN, LATIMER, LIFTON, LUPARDO, MAGEE, MAISEL, MARKEY, MAYERSOHN,
McENENY, MENG, J. MILLER, PRETLOW, REILLY, RUSSELL, SCHIMEL, SWEENEY,
TOWNS, WEISENBERG -- read once and referred to the Committee on Insur-
ance -- committee discharged, bill amended, ordered reprinted as
amended and recommitted to said committee -- recommitted to the
Committee on Insurance in accordance with Assembly Rule 3, sec. 2 --
committee discharged, bill amended, 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:
Section 1. Legislative findings. The legislature finds that advances
in medical research have led to significant new developments of various
medical treatments. These treatments offer patients a wide range of new
choices to combat very serious diseases. The area of cancer treatment
has been one of the fields that has seen these significant new medical
advancements. In recent years, oral chemotherapy treatments have been
developed that provide viable alternatives to traditional intravenous
cancer treatments for patients. This oral chemotherapy treatment offers
the treating physician and the patient a choice in relation to treatment
options. However, this choice is sometimes limited as the oral chemoth-
erapy treatments are, in most cases, covered under the prescription drug
benefit of an insurance plan rather than under the major medical insur-
ance benefit of an insurance plan. This discrepancy in coverage can
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD10074-06-0
A. 7355--B 2
limit a patient's ability to choose the oral chemotherapy treatment
because of the cost associated with the disparate treatment.
S 2. Subsection (i) of section 3216 of the insurance law is amended by
adding a new paragraph 12-a to read as follows:
(12-A) (A) EVERY POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE
THAT PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR COMPREHENSIVE-TYPE
COVERAGE AND PROVIDES COVERAGE FOR CANCER CHEMOTHERAPY TREATMENT SHALL
PROVIDE COVERAGE FOR A PRESCRIBED, ORALLY ADMINISTERED ANTICANCER MEDI-
CATION USED TO KILL OR SLOW THE GROWTH OF CANCEROUS CELLS ON A BASIS NO
LESS FAVORABLE THAN: (I) INTRAVENOUSLY ADMINISTERED OR INJECTED CANCER
MEDICATIONS; OR (II) PRESCRIBED DRUGS AS COVERED UNDER THE ENROLLEE'S
PRESCRIPTION DRUG BENEFIT, WHICHEVER IS LESS.
(B) A POLICY SHALL NOT ACHIEVE COMPLIANCE WITH THIS PARAGRAPH BY
IMPOSING AN INCREASE IN CO-PAYMENT, DEDUCTIBLE OR CO-INSURANCE AMOUNT
FOR AN INTRAVENOUSLY ADMINISTERED OR INJECTED CANCER MEDICATION COVERED
UNDER THE POLICY.
S 3. Subsection (k) of section 3221 of the insurance law is amended by
adding a new paragraph 9-a to read as follows:
(9-A) (A) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIV-
ERY IN THIS STATE THAT PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR
COMPREHENSIVE-TYPE COVERAGE AND PROVIDES COVERAGE FOR CANCER CHEMOTHERA-
PY TREATMENT SHALL PROVIDE COVERAGE FOR A PRESCRIBED, ORALLY ADMINIS-
TERED ANTICANCER MEDICATION USED TO KILL OR SLOW THE GROWTH OF CANCEROUS
CELLS ON A BASIS NO LESS FAVORABLE THAN: (I) INTRAVENOUSLY ADMINISTERED
OR INJECTED CANCER MEDICATIONS; OR (II) PRESCRIBED DRUGS AS COVERED
UNDER THE ENROLLEE'S PRESCRIPTION DRUG BENEFIT, WHICHEVER IS LESS.
(B) A POLICY SHALL NOT ACHIEVE COMPLIANCE WITH THIS PARAGRAPH BY
IMPOSING AN INCREASE IN CO-PAYMENT, DEDUCTIBLE OR CO-INSURANCE AMOUNT
FOR AN INTRAVENOUSLY ADMINISTERED OR INJECTED CANCER MEDICATION COVERED
UNDER THE POLICY.
S 4. Section 4303 of the insurance law is amended by adding a new
subsection (q-1) to read as follows:
(Q-1) (1) EVERY POLICY ISSUED BY A MEDICAL EXPENSE INDEMNITY CORPO-
RATION, A HOSPITAL SERVICE CORPORATION OR A HEALTH SERVICE CORPORATION
FOR DELIVERY IN THIS STATE THAT PROVIDES MEDICAL, MAJOR MEDICAL, OR
SIMILAR COMPREHENSIVE-TYPE COVERAGE AND PROVIDES COVERAGE FOR CANCER
CHEMOTHERAPY TREATMENT SHALL PROVIDE COVERAGE FOR A PRESCRIBED, ORALLY
ADMINISTERED ANTICANCER MEDICATION USED TO KILL OR SLOW THE GROWTH OF
CANCEROUS CELLS ON A BASIS NO LESS FAVORABLE THAN: (A) INTRAVENOUSLY
ADMINISTERED OR INJECTED CANCER MEDICATIONS; OR (B) PRESCRIBED DRUGS AS
COVERED UNDER THE ENROLLEE'S PRESCRIPTION DRUG BENEFIT, WHICHEVER IS
LESS.
(2) A POLICY SHALL NOT ACHIEVE COMPLIANCE WITH THIS SUBSECTION BY
IMPOSING AN INCREASE IN CO-PAYMENT, DEDUCTIBLE OR CO-INSURANCE AMOUNT
FOR AN INTRAVENOUSLY ADMINISTERED OR INJECTED CANCER MEDICATION COVERED
UNDER THE POLICY.
S 5. This act shall take effect immediately and shall apply to poli-
cies issued, modified, or renewed on or after such effective date.