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

                                  6055

                            I N  S E N A T E

                               (PREFILED)

                             January 4, 2012
                               ___________

Introduced  by  Sen.  LANZA  -- read twice and ordered printed, and when
  printed to be committed to the Committee on Insurance

AN ACT to amend the insurance law,  in  relation  to  coverage  of  oral
  chemotherapy treatment

  THE  PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:

  Section 1. Paragraph 12-a of subsection (i) of  section  3216  of  the
insurance  law,  as added by chapter 559 of the laws of 2011, is amended
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]
PROVIDES coverage for cancer chemotherapy treatment shall provide cover-
age  for  [a]  prescribed,  orally  administered anticancer [medication]
MEDICATIONS used to kill or slow the  growth  of  cancerous  cells  [and
shall  apply  the lower cost sharing of either (i) anticancer medication
under the prescription drug benefit  or  (ii)].  SUCH  COVERAGE  MAY  BE
SUBJECT  TO  CO-PAYS,  COINSURANCE  OR  DEDUCTIBLES,  PROVIDED  THAT THE
CO-PAYS, COINSURANCE OR DEDUCTIBLES ARE AT  LEAST  AS  FAVORABLE  TO  AN
INSURED  AS THE CO-PAYS, COINSURANCE OR DEDUCTIBLES THAT APPLY TO COVER-
AGE  FOR  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;

 EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
                      [ ] is old law to be omitted.
                                                           LBD13718-01-1
              

S. 6055                             2

  (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 2. Paragraph 12-a of subsection (1) of section 3221 of the insurance
law,  as added by chapter 559 of the laws of 2011, is amended 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] MEDICATIONS
used to kill or slow the growth of cancerous cells [and shall apply  the
lower  cost  sharing  of  either  (i)  anticancer  medication  under the
prescription drug benefit or (ii)].   SUCH COVERAGE MAY  BE  SUBJECT  TO
CO-PAYS,  COINSURANCE OR DEDUCTIBLES, PROVIDED THAT THE CO-PAYS, COINSU-
RANCE OR DEDUCTIBLES ARE AT LEAST AS FAVORABLE  TO  AN  INSURED  AS  THE
CO-PAYS,  COINSURANCE OR DEDUCTIBLES THAT APPLY TO COVERAGE FOR intrave-
nous or injected anticancer  medications.  [For  the  purposes  of  this
section  "cost  sharing" shall include co-pays, coinsurance, and deduct-
ibles 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 (q-1) of section 4303 of the insurance law, as added
by chapter 559 of the laws of 2011, is amended to read as follows:
  (q-1) (1) Every [policy] CONTRACT issued by a medical  expense  indem-
nity  corporation,  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]
MEDICATIONS used to kill or slow the  growth  of  cancerous  cells  [and
shall  apply  the lower cost sharing of either (A) anticancer medication
under the prescription drug  benefit  or  (B)].  SUCH  COVERAGE  MAY  BE

S. 6055                             3

SUBJECT  TO  CO-PAYS,  COINSURANCE  OR  DEDUCTIBLES,  PROVIDED  THAT THE
CO-PAYS, COINSURANCE OR DEDUCTIBLES ARE AT  LEAST  AS  FAVORABLE  TO  AN
INSURED  AS THE CO-PAYS, COINSURANCE OR DEDUCTIBLES THAT APPLY TO COVER-
AGE  FOR  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] CONTRACT 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 4. This act shall take effect on the  same  date  and  in  the  same
manner as chapter 559 of the laws of 2011, takes effect.