Senate Bill S5864A

                            
                    S T A T E   O F   N E W   Y O R K
________________________________________________________________________

                                 5864--A
    Cal. No. 750

                       2009-2010 Regular Sessions

                            I N  S E N A T E

                              June 15, 2009
                               ___________

Introduced  by  Sens.  HASSELL-THOMPSON,  ALESI,  DILAN, FOLEY, KRUEGER,
  LANZA, LEIBELL, PERKINS,  SCHNEIDERMAN,  STACHOWSKI,  STEWART-COUSINS,
  THOMPSON  --  read  twice  and ordered printed, and when printed to be
  committed to the Committee on Rules -- recommitted to the Committee on
  Insurance in accordance with Senate Rule 6, sec. 8 -- reported favora-
  bly from said committee, ordered to first and second  report,  ordered
  to a third reading, amended and ordered reprinted, retaining its place
  in the order of third reading

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
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

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
              

                                                           LBD10074-05-0

S. 5864--A                          2

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.