NY State Senate Bill 2011-S3988

Archive: Last Bill Status - Signed by Governor

Introduced
- In Committee Assembly
- In Committee Senate
- On Floor Calendar Assembly
- On Floor Calendar Senate
- Passed Assembly
- Passed Senate
Delivered to Governor
Signed By Governor

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Actions

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Date of Action	Assembly Actions - Lowercase Senate Actions - UPPERCASE
Sep 23, 2011	approval memo.10 signed chap.559
Sep 12, 2011	delivered to governor
Jun 22, 2011	returned to senate passed assembly ordered to third reading rules cal.569 substituted for a6233b
Jun 20, 2011	referred to insurance delivered to assembly passed senate ordered to third reading cal.1384 committee discharged and committed to rules
Jun 16, 2011	print number 3988b
Jun 16, 2011	amend and recommit to insurance
Jun 15, 2011	print number 3988a
Jun 15, 2011	amend and recommit to insurance
Mar 11, 2011	referred to insurance

Votes

- Jun 20, 2011 - Floor Vote
  S3988
  
  Aye
  
  61
  
  Nay
  
  1
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  
  0
  - - Floor Vote: Jun 20, 2011
      
      aye (61)
      
      Adams
      
      Addabbo Jr.
      
      Alesi
      
      Avella
      
      Ball
      
      Bonacic
      
      Breslin
      
      Carlucci
      
      DeFrancisco
      
      Diaz
      
      Dilan
      
      Duane
      
      Espaillat
      
      Farley
      
      Flanagan
      
      Fuschillo
      
      Gallivan
      
      Gianaris
      
      Golden
      
      Griffo
      
      Grisanti
      
      Hannon
      
      Hassell-Thompson
      
      Huntley
      
      Johnson
      
      Kennedy
      
      Klein
      
      Krueger
      
      Kruger
      
      LaValle
      
      Lanza
      
      Larkin
      
      Libous
      
      Little
      
      Marcellino
      
      Martins
      
      Maziarz
      
      McDonald
      
      Montgomery
      
      Nozzolio
      
      O'Mara
      
      Oppenheimer
      
      Parker
      
      Peralta
      
      Perkins
      
      Ranzenhofer
      
      Ritchie
      
      Rivera
      
      Robach
      
      Saland
      
      Sampson
      
      Savino
      
      Serrano
      
      Skelos
      
      Smith
      
      Squadron
      
      Stavisky
      
      Stewart-Cousins
      
      Valesky
      
      Young
      
      Zeldin
      
      nay (1)
      
      Seward
  Jun 20, 2011 - Rules Committee Vote
  S3988
  
  Aye
  
  22
  
  Nay
  
  0
  
  Aye with Reservations
  
  1
  
  Absent
  
  0
  
  Excused
  
  0
  
  Abstained
  
  1
  - - Rules Committee Vote: Jun 20, 2011
      
      aye (22)
      
      Alesi
      
      Breslin
      
      Dilan
      
      Duane
      
      Farley
      
      Hannon
      
      Hassell-Thompson
      
      Johnson
      
      Krueger
      
      LaValle
      
      Larkin
      
      Libous
      
      Marcellino
      
      Maziarz
      
      Nozzolio
      
      Parker
      
      Perkins
      
      Saland
      
      Sampson
      
      Skelos
      
      Smith
      
      Stewart-Cousins
      
      aye wr (1)
      
      Seward
      
      abstained (1)
      
      Montgomery

Bill Amendments

Original

B (Active)

co-Sponsors

View additional co-sponsors

2011-S3988 - Details

See Assembly Version of this Bill:: A6233
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2009-2010 Legislative Session:: S5864, A7355

2011-S3988 - Summary

Requires coverage of orally administered chemotherapy treatments.

2011-S3988 - Sponsor Memo

                                BILL NUMBER:S3988

TITLE OF BILL:
An act
to amend the insurance law, in relation to policy coverage of
chemotherapy treatment

PURPOSE:
To require health insurance plans in New York to cover orally
administered chemotherapy treatment no less favorably than
intravenously administered or injected chemotherapy treatments.

SUMMARY OF SPECIFIC PROVISIONS:
This bill amends section 3221 subdivision k of the Insurance law by
adding a new subsection 9-A.

JUSTIFICATION:
Medical advances over the years have led to many beneficial medical
treatments. One of these medical advances has been the development of
an oral chemotherapy treatment. With this treatment, a patient is
able to undergo chemotherapy by taking a pill in the comfort of their
own home. This means that the patient does not have to go to the
hospital for the traditional intravenous' or injectable form of
chemotherapy that is most commonly thought of when chemotherapy is
discussed. In addition to being able to do the treatment in their own
home, the patient also receives the added benefit of possibly not

having the traditionally chemotherapy side effects such as hair loss
and the patient also sleeps through the treatment as the pill is
administered at bedtime, meaning that the patient sleeps while the
drugs do their work.

This medical advance is significant. However, due to a classification
by insurance companies, many patients cannot reap the benefits of
this advance. As this chemotherapy treatment comes in the form of a
pill, insurance companies are classifying this treatment as a
prescription drug treatment. This means that the patient does not get
the treatment covered as a traditional chemotherapy treatment and
must pay for the drug as though it were an average prescription drug.
As this is not an average prescription drug, the co-pay and coverage
for this drug are limited. Most patients must payout of pocket in the
highest drug price category. This means that for the majority of
patients, the pill form of chemotherapy will cost tens of thousands
of dollars. This is obviously cost prohibitive and limits patient
access to a viable and desirable alternative to traditional
chemotherapy treatment.

Traditional chemotherapy treatment is usually covered under the major
medical benefits, and once the deductible is met, if there even is
one, the treatment is 100% covered. This amendment to the New York
State Insurance Law would correct this discrepancy and ensure that
chemotherapy treatment, no matter how administered, is covered
equally by insurance companies.

LEGISLATIVE HISTORY:
2010: S.4516 - Referred to Insurance.
2009: S.4516 - Referred to Insurance.


FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This law would take effect on the first of January next succeeding the
date on which it shall become a law and shall apply to all policies
and contracts issued, renewed, modified, altered or amended after the
effective date.

2011-S3988 - Bill Text download pdf

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

                                  3988

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 11, 2011
                               ___________

Introduced  by  Sens.  LANZA, HASSELL-THOMPSON -- read twice and ordered
  printed, and when printed to be committed to the Committee  on  Insur-
  ance

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
COVERAGE AND PROVIDES COVERAGE FOR PRESCRIPTION  DRUGS  AND  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: (I) INTRAVENOUSLY
ADMINISTERED OR INJECTED CANCER MEDICATIONS;  OR,  IF  APPLICABLE,  (II)

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09290-02-1

S. 3988                             2

PRESCRIBED DRUGS AS COVERED UNDER THE ENROLLEE'S PRESCRIPTION DRUG BENE-
FIT, 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 PRESCRIPTION DRUGS
AND  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:
(I) INTRAVENOUSLY ADMINISTERED OR INJECTED CANCER  MEDICATIONS;  OR,  IF
APPLICABLE,  (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
PRESCRIPTION DRUGS AND 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 MEDI-
CATIONS; OR, IF APPLICABLE, (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 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.

co-Sponsors

View additional co-sponsors

2011-S3988A - Details

See Assembly Version of this Bill:: A6233
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2009-2010 Legislative Session:: S5864, A7355

2011-S3988A - Summary

Requires coverage of orally administered chemotherapy treatments.

2011-S3988A - Sponsor Memo

                                BILL NUMBER:S3988A

TITLE OF BILL:
An act
to amend the insurance law, in relation to policy coverage of
chemotherapy treatment

PURPOSE:
To require health insurance plans in New York to cover orally
administered chemotherapy treatment no less favorably than
intravenously administered or injected chemotherapy treatments.

SUMMARY OF SPECIFIC PROVISIONS:
This bill amends section 3221 subdivision k of the Insurance law by
adding a new subsection 9-A.

JUSTIFICATION:
Medical advances over the years have led to many beneficial medical
treatments. One of these medical advances has been the development of
an oral chemotherapy treatment. With this treatment, a patient is
able to undergo chemotherapy by taking a pill in the comfort of their
own home. This means that the patient does not have to go to the
hospital for the traditional intravenous' or injectable form of
chemotherapy that is most commonly thought of when chemotherapy is
discussed. In addition to being able to do the treatment in their own
home, the patient also receives the added benefit of possibly not

having the traditionally chemotherapy side effects such as hair loss
and the patient also sleeps through the treatment as the pill is
administered at bedtime, meaning that the patient sleeps while the
drugs do their work.

This medical advance is significant. However, due to a classification
by insurance companies, many patients cannot reap the benefits of
this advance. As this chemotherapy treatment comes in the form of a
pill, insurance companies are classifying this treatment as a
prescription drug treatment. This means that the patient does not get
the treatment covered as a traditional chemotherapy treatment and
must pay for the drug as though it were an average prescription drug.
As this is not an average prescription drug, the co-pay and coverage
for this drug are limited. Most patients must payout of pocket in the
highest drug price category. This means that for the majority of
patients, the pill form of chemotherapy will cost tens of thousands
of dollars. This is obviously cost prohibitive and limits patient
access to a viable and desirable alternative to traditional
chemotherapy treatment.

Traditional chemotherapy treatment is usually covered under the major
medical benefits, and once the deductible is met, if there even is
one, the treatment is 100% covered. This amendment to the New York
State Insurance Law would correct this discrepancy and ensure that
chemotherapy treatment, no matter how administered, is covered
equally by insurance companies.

LEGISLATIVE HISTORY:
2010: S.4516 - Referred to Insurance.
2009: S.4516 - Referred to Insurance.


FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This law would take effect on the first of January next succeeding the
date on which it shall become a law and shall apply to all policies
and contracts issued, renewed, modified, altered or amended after the
effective date.

2011-S3988A - Bill Text download pdf

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

                                 3988--A

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 11, 2011
                               ___________

Introduced  by  Sens.  LANZA,  HASSELL-THOMPSON,  ALESI, ADAMS, ADDABBO,
  AVELLA, DeFRANCISCO, DIAZ, GOLDEN, GRISANTI, KENNEDY, KLEIN,  KRUEGER,
  LARKIN, MARTINS, MAZIARZ, OPPENHEIMER -- read twice and ordered print-
  ed,  and when printed to be committed 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 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
COVERAGE AND PROVIDES COVERAGE FOR PRESCRIPTION DRUGS AND  ALSO  PROVIDE
COVERAGE  FOR CANCER CHEMOTHERAPY TREATMENT SHALL PROVIDE COVERAGE FOR A

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09290-04-1

S. 3988--A                          2

PRESCRIBED, ORALLY ADMINISTERED ANTICANCER MEDICATION USED  TO  KILL  OR
SLOW  THE GROWTH OF CANCEROUS CELLS AND SHALL APPLY THE LOWER COST SHAR-
ING OF EITHER (I) ANTICANCER  MEDICATION  UNDER  THE  PRESCRIPTION  DRUG
BENEFIT  OR (II) INTRAVENOUS OR INJECTED ANTICANCER MEDICATIONS. FOR THE
PURPOSES OF THIS SECTION "COST SHARING" SHALL INCLUDE  CO-PAYS,  COINSU-
RANCE, AND DEDUCTIBLES AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
  (B) AN INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH AND ANY PARTIC-
IPATING  ENTITY  THROUGH  WHICH THE INSURER OFFERS HEALTH SERVICES SHALL
NOT:
  (I) VARY THE TERMS OF THE POLICY FOR THE PURPOSE OR WITH THE EFFECT OF
AVOIDING COMPLIANCE WITH THIS PARAGRAPH;
  (II) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO ENCOURAGE A COVERED
PERSON TO ACCEPT LESS THAN THE MINIMUM PROTECTIONS AVAILABLE UNDER  THIS
PARAGRAPH;
  (III)  PENALIZE  IN  ANY  WAY OR REDUCE OR LIMIT THE COMPENSATION OF A
HEALTH CARE PRACTITIONER FOR RECOMMENDING OR PROVIDING CARE TO A COVERED
PERSON IN ACCORDANCE WITH THIS PARAGRAPH;
  (IV) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO A HEALTH CARE PRAC-
TITIONER RELATING TO THE SERVICES PROVIDED PURSUANT  TO  THIS  PARAGRAPH
INTENDED  TO  INDUCE OR HAVE THE EFFECT OF INDUCING SUCH PRACTITIONER TO
PROVIDE CARE TO A COVERED PERSON IN  A  MANNER  INCONSISTENT  WITH  THIS
PARAGRAPH; OR
  (V)  ACHIEVE COMPLIANCE WITH THIS PARAGRAPH BY IMPOSING AN INCREASE IN
COST SHARING FOR AN INTRAVENOUS OR INJECTED ANTICANCER MEDICATION.
  S 3. Subsection (l) of section 3221 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 PRESCRIPTION DRUGS AND ALSO 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 AND SHALL APPLY THE LOWER COST  SHAR-
ING  OF  EITHER  (I)  ANTICANCER  MEDICATION UNDER THE PRESCRIPTION DRUG
BENEFIT OR (II) INTRAVENOUS OR INJECTED ANTICANCER MEDICATIONS. FOR  THE
PURPOSES  OF  THIS SECTION "COST SHARING" SHALL INCLUDE CO-PAYS, COINSU-
RANCE, AND DEDUCTIBLES AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
  (B) AN INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH AND ANY PARTIC-
IPATING ENTITY THROUGH WHICH THE INSURER OFFERS  HEALTH  SERVICES  SHALL
NOT:
  (I) VARY THE TERMS OF THE POLICY FOR THE PURPOSE OR WITH THE EFFECT OF
AVOIDING COMPLIANCE WITH THIS PARAGRAPH;
  (II) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO ENCOURAGE A COVERED
PERSON  TO ACCEPT LESS THAN THE MINIMUM PROTECTIONS AVAILABLE UNDER THIS
PARAGRAPH;
  (III) PENALIZE IN ANY WAY OR REDUCE OR LIMIT  THE  COMPENSATION  OF  A
HEALTH CARE PRACTITIONER FOR RECOMMENDING OR PROVIDING CARE TO A COVERED
PERSON IN ACCORDANCE WITH THIS PARAGRAPH;
  (IV) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO A HEALTH CARE PRAC-
TITIONER  RELATING  TO  THE SERVICES PROVIDED PURSUANT TO THIS PARAGRAPH
INTENDED TO INDUCE OR HAVE THE EFFECT OF INDUCING SUCH  PRACTITIONER  TO
PROVIDE  CARE  TO  A  COVERED  PERSON IN A MANNER INCONSISTENT WITH THIS
PARAGRAPH; OR
  (V) ACHIEVE COMPLIANCE WITH THIS PARAGRAPH BY IMPOSING AN INCREASE  IN
COST SHARING FOR AN INTRAVENOUS OR INJECTED ANTICANCER MEDICATION.
  S  4.  Section  4603  of  the insurance law is amended by adding a new
subsection  (q-l) to read as follows:

S. 3988--A                          3

  (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 SIMI-
LAR COMPREHENSIVE-TYPE COVERAGE AND PROVIDES COVERAGE  FOR  PRESCRIPTION
DRUGS AND FOR CANCER CHEMOTHERAPY TREATMENT SHALL PROVIDE COVERAGE FOR A
PRESCRIBED,  ORALLY  ADMINISTERED  ANTICANCER MEDICATION USED TO KILL OR
SLOW THE GROWTH OF CANCEROUS CELLS AND SHALL APPLY THE LOWER COST  SHAR-
ING  OF  EITHER  (A)  ANTICANCER  MEDICATION UNDER THE PRESCRIPTION DRUG
BENEFIT OR (B) INTRAVENOUS OR INJECTED ANTICANCER MEDICATIONS.  FOR  THE
PURPOSES OF THIS SECTION "COST SHARING" SHALL INCLUDE CO-PAYMENTS, COIN-
SURANCE, AND DEDUCTIBLES AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
  (2) AN INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH AND ANY PARTIC-
IPATING  ENTITY  THROUGH  WHICH THE INSURER OFFERS HEALTH SERVICES SHALL
NOT:
  (A) VARY THE TERMS OF THE POLICY FOR THE PURPOSE OR WITH THE EFFECT OF
AVOIDING COMPLIANCE WITH THIS PARAGRAPH;
  (B) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO ENCOURAGE A  COVERED
PERSON  TO ACCEPT LESS THAN THE MINIMUM PROTECTIONS AVAILABLE UNDER THIS
PARAGRAPH;
  (C) PENALIZE IN ANY WAY OR REDUCE  OR  LIMIT  THE  COMPENSATION  OF  A
HEALTH CARE PRACTITIONER FOR RECOMMENDING OR PROVIDING CARE TO A COVERED
PERSON IN ACCORDANCE WITH THIS PARAGRAPH;
  (D)  PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO A HEALTH CARE PRAC-
TITIONER RELATING TO THE SERVICES PROVIDED PURSUANT  TO  THIS  PARAGRAPH
INTENDED  TO INDUCE OR HAVE THE EFFECT OF  INDUCING SUCH PRACTITIONER TO
PROVIDE CARE TO A COVERED PERSON IN  A  MANNER  INCONSISTENT  WITH  THIS
PARAGRAPH; OR
  (E)  ACHIEVE COMPLIANCE WITH THIS PARAGRAPH BY IMPOSING AN INCREASE IN
COST SHARING FOR AN INTRAVENOUS OR INJECTED ANTICANCER MEDICATION.
  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.

co-Sponsors

View additional co-sponsors

2011-S3988B (ACTIVE) - Details

See Assembly Version of this Bill:: A6233
Law Section:: Insurance Law
Laws Affected:: Amd §§3216, 3221 & 4303, Ins L
Versions Introduced in 2009-2010 Legislative Session:: S5864, A7355

2011-S3988B (ACTIVE) - Summary

Requires coverage of orally administered chemotherapy treatments.

2011-S3988B (ACTIVE) - Sponsor Memo

                                BILL NUMBER:S3988B

TITLE OF BILL:
An act
to amend the insurance law, in relation to policy coverage of
chemotherapy treatment

PURPOSE:
To require health insurance plans in New York to cover orally
administered chemotherapy treatment no less favorably than
intravenously administered or injected chemotherapy treatments.

SUMMARY OF PROVISIONS:
Section one is the legislative intent.

Section two amends subsection (i) of section 3216 of the insurance law
by adding a new paragraph 12-a.

Section three amends subsection 3221 of the insurance law by adding a
new paragraph 12-a.

Section four Amends section 4303 of the insurance law by adding a new
subsection (q-1).

Section five is the effective date.

JUSTIFICATION:
Medical advances over the years have led to many beneficial medical
treatments. One of these medical advances has been the development of
an oral chemotherapy treatment. With this treatment, a patient is
able to undergo chemotherapy by taking a pill in the comfort of their
own home. This means that the patient does not have to go to the
hospital for the traditional intravenous or injectable form of
chemotherapy that is most commonly thought of when chemotherapy is
discussed. In addition to being able to do the treatment in their own
home, the patient also receives the added benefit of possibly not
having the traditionally chemotherapy side effects such as hair loss
and the patient also sleeps through the treatment as the pill is
administered at bedtime, meaning that the patient sleeps while the
drugs do their work.

This medical advance is significant. However, due to a classification
by insurance companies, many patients cannot reap the benefits of
this advance. As this chemotherapy treatment comes in the form of a
pill, insurance companies are classifying this treatment as a
prescription drug treatment. This means that the patient does not get
the treatment covered as a traditional chemotherapy treatment and
must pay for the drug as though it were an
average prescription drug. As this is not an average prescription
drug, the co-pay and coverage for this drug are limited. Most
patients must payout of pocket in the highest drug price category.
This means that for the majority of patients, the pill form of
chemotherapy will cost tens of thousands of dollars. This is
obviously cost prohibitive and limits patient access to a viable and
desirable alternative to traditional chemotherapy treatment.


Traditional chemotherapy treatment is usually covered under the major
medical benefits, and once the deductible is met, if there even is
one, the treatment is 100% covered. This amendment to the New York
State Insurance Law would correct this discrepancy and ensure that
chemotherapy treatment, no matter how administered, is covered
equally by insurance companies.

LEGISLATIVE HISTORY:
2010: S.4516 - Referred to Insurance.
2009: S.4516 - Referred to Insurance.

FISCAL IMPLICATIONS:
None.

EFFECTIVE DATE:
This law would take effect on the first of January next succeeding the
date on which it shall become a law and shall apply to all policies
and contracts issued, renewed, modified, altered or amended after the
effective date.

2011-S3988B (ACTIVE) - Bill Text download pdf

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

                                 3988--B

                       2011-2012 Regular Sessions

                            I N  S E N A T E

                             March 11, 2011
                               ___________

Introduced  by  Sens.  LANZA,  HASSELL-THOMPSON,  ALESI, ADAMS, ADDABBO,
  AVELLA, DeFRANCISCO, DIAZ, GOLDEN, GRISANTI, KENNEDY, KLEIN,  KRUEGER,
  LARKIN, MARTINS, MAZIARZ, OPPENHEIMER -- read twice and ordered print-
  ed,  and when printed to be committed to the Committee on Insurance --
  committee discharged, bill amended, ordered reprinted as  amended  and
  recommitted  to  said committee -- 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
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 PRESCRIPTION DRUGS AND ALSO PROVIDE

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD09290-06-1

S. 3988--B                          2

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 AND SHALL APPLY THE LOWER COST  SHAR-
ING  OF  EITHER  (I)  ANTICANCER  MEDICATION UNDER THE PRESCRIPTION DRUG
BENEFIT OR (II) INTRAVENOUS OR INJECTED ANTICANCER MEDICATIONS. FOR  THE
PURPOSES  OF  THIS SECTION "COST SHARING" SHALL INCLUDE CO-PAYS, COINSU-
RANCE, AND DEDUCTIBLES AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
  (B) AN INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH AND ANY PARTIC-
IPATING ENTITY THROUGH WHICH THE INSURER OFFERS  HEALTH  SERVICES  SHALL
NOT:
  (I) VARY THE TERMS OF THE POLICY FOR THE PURPOSE OR WITH THE EFFECT OF
AVOIDING COMPLIANCE WITH THIS PARAGRAPH;
  (II) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO ENCOURAGE A COVERED
PERSON  TO ACCEPT LESS THAN THE MINIMUM PROTECTIONS AVAILABLE UNDER THIS
PARAGRAPH;
  (III) PENALIZE IN ANY WAY OR REDUCE OR LIMIT  THE  COMPENSATION  OF  A
HEALTH CARE PRACTITIONER FOR RECOMMENDING OR PROVIDING CARE TO A COVERED
PERSON IN ACCORDANCE WITH THIS PARAGRAPH;
  (IV) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO A HEALTH CARE PRAC-
TITIONER  RELATING  TO  THE SERVICES PROVIDED PURSUANT TO THIS PARAGRAPH
INTENDED TO INDUCE OR HAVE THE EFFECT OF INDUCING SUCH  PRACTITIONER  TO
PROVIDE  CARE  TO  A  COVERED  PERSON IN A MANNER INCONSISTENT WITH THIS
PARAGRAPH; OR
  (V) ACHIEVE COMPLIANCE WITH THIS PARAGRAPH BY IMPOSING AN INCREASE  IN
COST SHARING FOR AN INTRAVENOUS OR INJECTED ANTICANCER MEDICATION.
  S 3. Subsection (l) of section 3221 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 PRESCRIPTION DRUGS AND ALSO  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 AND SHALL APPLY THE LOWER COST SHAR-
ING OF EITHER (I) ANTICANCER  MEDICATION  UNDER  THE  PRESCRIPTION  DRUG
BENEFIT  OR (II) INTRAVENOUS OR INJECTED ANTICANCER MEDICATIONS. FOR THE
PURPOSES OF THIS SECTION "COST SHARING" SHALL INCLUDE  CO-PAYS,  COINSU-
RANCE, AND DEDUCTIBLES AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
  (B) AN INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH AND ANY PARTIC-
IPATING  ENTITY  THROUGH  WHICH THE INSURER OFFERS HEALTH SERVICES SHALL
NOT:
  (I) VARY THE TERMS OF THE POLICY FOR THE PURPOSE OR WITH THE EFFECT OF
AVOIDING COMPLIANCE WITH THIS PARAGRAPH;
  (II) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO ENCOURAGE A COVERED
PERSON TO ACCEPT LESS THAN THE MINIMUM PROTECTIONS AVAILABLE UNDER  THIS
PARAGRAPH;
  (III)  PENALIZE  IN  ANY  WAY OR REDUCE OR LIMIT THE COMPENSATION OF A
HEALTH CARE PRACTITIONER FOR RECOMMENDING OR PROVIDING CARE TO A COVERED
PERSON IN ACCORDANCE WITH THIS PARAGRAPH;
  (IV) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO A HEALTH CARE PRAC-
TITIONER RELATING TO THE SERVICES PROVIDED PURSUANT  TO  THIS  PARAGRAPH
INTENDED  TO  INDUCE OR HAVE THE EFFECT OF INDUCING SUCH PRACTITIONER TO
PROVIDE CARE TO A COVERED PERSON IN  A  MANNER  INCONSISTENT  WITH  THIS
PARAGRAPH; OR
  (V)  ACHIEVE COMPLIANCE WITH THIS PARAGRAPH BY IMPOSING AN INCREASE IN
COST SHARING FOR AN INTRAVENOUS OR INJECTED ANTICANCER MEDICATION.

S. 3988--B                          3

  S 4. Section 4303 of the insurance law is  amended  by  adding  a  new
subsection  (q-l) 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 SIMI-
LAR  COMPREHENSIVE-TYPE  COVERAGE AND PROVIDES COVERAGE FOR PRESCRIPTION
DRUGS AND FOR CANCER CHEMOTHERAPY TREATMENT SHALL PROVIDE COVERAGE FOR A
PRESCRIBED, ORALLY ADMINISTERED ANTICANCER MEDICATION USED  TO  KILL  OR
SLOW  THE GROWTH OF CANCEROUS CELLS AND SHALL APPLY THE LOWER COST SHAR-
ING OF EITHER (A) ANTICANCER  MEDICATION  UNDER  THE  PRESCRIPTION  DRUG
BENEFIT  OR  (B) INTRAVENOUS OR INJECTED ANTICANCER MEDICATIONS. FOR THE
PURPOSES OF THIS SECTION "COST SHARING" SHALL INCLUDE CO-PAYMENTS, COIN-
SURANCE, AND DEDUCTIBLES AS DEEMED APPROPRIATE BY THE SUPERINTENDENT.
  (2) AN INSURER PROVIDING COVERAGE UNDER THIS PARAGRAPH AND ANY PARTIC-
IPATING ENTITY THROUGH WHICH THE INSURER OFFERS  HEALTH  SERVICES  SHALL
NOT:
  (A) VARY THE TERMS OF THE POLICY FOR THE PURPOSE OR WITH THE EFFECT OF
AVOIDING COMPLIANCE WITH THIS PARAGRAPH;
  (B)  PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO ENCOURAGE A COVERED
PERSON TO ACCEPT LESS THAN THE MINIMUM PROTECTIONS AVAILABLE UNDER  THIS
PARAGRAPH;
  (C)  PENALIZE  IN  ANY  WAY  OR  REDUCE OR LIMIT THE COMPENSATION OF A
HEALTH CARE PRACTITIONER FOR RECOMMENDING OR PROVIDING CARE TO A COVERED
PERSON IN ACCORDANCE WITH THIS PARAGRAPH;
  (D) PROVIDE INCENTIVES (MONETARY OR OTHERWISE) TO A HEALTH CARE  PRAC-
TITIONER  RELATING  TO  THE SERVICES PROVIDED PURSUANT TO THIS PARAGRAPH
INTENDED TO INDUCE OR HAVE THE EFFECT OF  INDUCING SUCH PRACTITIONER  TO
PROVIDE  CARE  TO  A  COVERED  PERSON IN A MANNER INCONSISTENT WITH THIS
PARAGRAPH; OR
  (E) ACHIEVE COMPLIANCE WITH THIS PARAGRAPH BY IMPOSING AN INCREASE  IN
COST SHARING FOR AN INTRAVENOUS OR INJECTED ANTICANCER MEDICATION.
  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.

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Senate Bill S3988

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