S T A T E O F N E W Y O R K
________________________________________________________________________
7533
2019-2020 Regular Sessions
I N A S S E M B L Y
May 9, 2019
___________
Introduced by M. of A. FAHY -- read once and referred to the Committee
on Health
AN ACT to amend the public health law, in relation to requiring dihydro-
pyrimidine dehydrogenase deficiency testing for certain individuals
with cancer; to amend the insurance law, in relation to requiring
policies and contracts of insurance to include coverage for dihydropy-
rimidine dehydrogenase deficiency testing; and to amend the social
services law, in relation to the provision of dihydropyrimidine dehyd-
rogenase deficiency testing under the medical assistance program
THE PEOPLE OF THE STATE OF NEW YORK, REPRESENTED IN SENATE AND ASSEM-
BLY, DO ENACT AS FOLLOWS:
Section 1. The public health law is amended by adding a new section
2400-a to read as follows:
§ 2400-A. DIHYDROPYRIMIDINE DEHYDROGENASE DEFICIENCY TESTING. 1. FOR
PURPOSES OF THIS SECTION THE FOLLOWING TERMS SHALL HAVE THE FOLLOWING
MEANINGS:
(A) "ANTIMETABOLITES" MEANS A SUBSTANCE THAT INTERFERES WITH THE
NORMAL METABOLIC PROCESSES WITHIN CELLS, TYPICALLY BY COMBINING WITH
ENZYMES.
(B) "DIHYDROPYRIMIDINE DEHYDROGENASE DEFICIENCY" MEANS A CONDITION IN
WHICH THE BODY CANNOT BREAK DOWN THE NUCLEOTIDES THYMINE AND URACIL.
(C) "FLUOROPYRMIDINE" MEANS A GROUP OF SUBSTANCES USED TO TREAT CANCER
THROUGH CHEMOTHERAPY.
2. EVERY PHYSICIAN OR OTHER AUTHORIZED PRACTITIONER WHO PROVIDES FLUO-
ROPYRMIDINE OR OTHER ANTIMETABOLITES TO INDIVIDUALS DIAGNOSED WITH
CANCER SHALL TEST FOR DIHYDROPYRIMIDINE DEHYDROGENASE DEFICIENCY PRIOR
TO SUCH TREATMENT.
§ 2. Subparagraph (A) of paragraph 12-a of subsection (i) of section
3216 of the insurance law, as amended by chapter 12 of the laws of 2012,
is amended to read as follows:
EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets
[ ] is old law to be omitted.
LBD02330-01-9
A. 7533 2
(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 prescribed,
orally administered anticancer medications used to kill or slow the
growth of cancerous cells, AND SHALL PROVIDE COVERAGE FOR DIHYDROPYRIMI-
DINE DEHYDROGENASE DEFICIENCY TESTING PRIOR TO SUCH TREATMENT WHERE SUCH
TREATMENT CONSISTS OF FLUOROPYRMIDINE OR OTHER ANTIMETABOLITES. 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
coverage for intravenous or injected anticancer medications.
§ 3. Subparagraph (A) of paragraph 12-a of subsection (l) of section
3221 of the insurance law, as amended by chapter 12 of the laws of 2012,
is amended to read as follows:
(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 prescribed,
orally administered anticancer medications used to kill or slow the
growth of cancerous cells, AND SHALL PROVIDE COVERAGE FOR DIHYDROPYRIMI-
DINE DEHYDROGENASE DEFICIENCY TESTING PRIOR TO SUCH TREATMENT WHERE SUCH
TREATMENT CONSISTS OF FLUOROPYRMIDINE OR OTHER ANTIMETABOLITES. 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
coverage for intravenous or injected anticancer medications.
§ 4. Paragraph 1 of subsection (q-1) of section 4303 of the insurance
law, as amended by chapter 12 of the laws of 2012, is amended to read as
follows:
(1) Every contract issued by a medical expense indemnity 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
prescribed, orally administered anticancer medications used to kill or
slow the growth of cancerous cells, AND SHALL PROVIDE COVERAGE FOR DIHY-
DROPYRIMIDINE DEHYDROGENASE DEFICIENCY TESTING PRIOR TO SUCH TREATMENT
WHERE SUCH TREATMENT CONSISTS OF FLUOROPYRMIDINE OR OTHER ANTIMETABOL-
ITES. Such coverage may be subject to co-pays, coinsurance or deduct-
ibles, provided that the co-pays, coinsurance or deductibles are at
least as favorable to an insured as the co-pays, coinsurance or deduct-
ibles that apply to coverage for intravenous or injected anticancer
medications.
§ 5. The social services law is amended by adding a new section 365-o
to read as follows:
§ 365-O. PROVISION OF DIHYDROPYRIMIDINE DEHYDROGENASE DEFICIENCY TEST-
ING. 1. THE COMMISSIONER SHALL ESTABLISH STANDARDS AND GUIDELINES FOR
THE PROVISION OF DIHYDROPYRIMIDINE DEHYDROGENASE DEFICIENCY TESTING
PRIOR TO CANCER TREATMENT THROUGH FLUOROPYRMIDINE OR OTHER ANTIMETABOL-
ITES UNDER THE MEDICAL ASSISTANCE PROGRAM.
2. FOR PURPOSES OF THIS SECTION:
(A) "ANTIMETABOLITES" MEANS A SUBSTANCE THAT INTERFERES WITH THE
NORMAL METABOLIC PROCESSES WITHIN CELLS, TYPICALLY BY COMBINING WITH
ENZYMES.
A. 7533 3
(B) "DIHYDROPYRIMIDINE DEHYDROGENASE DEFICIENCY" MEANS A CONDITION IN
WHICH THE BODY CANNOT BREAK DOWN THE NUCLEOTIDES THYMINE AND URACIL.
(C) "FLUOROPYRMIDINE" MEANS A GROUP OF SUBSTANCES USED TO TREAT CANCER
THROUGH CHEMOTHERAPY.
§ 6. This act shall take effect on the one hundred twentieth day after
it shall have become a law. Effective immediately, the addition, amend-
ment and/or repeal of any rule or regulation necessary for the implemen-
tation of this act on its effective date are authorized to be made and
completed on or before such effective date.