Requires coverage of orally administered chemotherapy treatments.
BILL NUMBER: S5864
TITLE OF BILL : An act to amend the insurance law, in relation to policy coverage of chemotherapy treatment
PURPOSE OF BILL : This bill would 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 : 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 : None.
FISCAL IMPLICATIONS : None to the state.
EFFECTIVE DATE : This law would take effect immediately.
STATE OF NEW YORK ________________________________________________________________________ 5864 2009-2010 Regular Sessions IN SENATE June 15, 2009 ___________Introduced by Sen. HASSELL-THOMPSON -- read twice and ordered printed, and when printed to be committed to the Committee on Rules 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) 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 INTRAVENOUSLY ADMINISTERED OR INJECTED CANCER MEDI- CATIONS.EXPLANATION--Matter in ITALICS (underscored) is new; matter in brackets [ ] is old law to be omitted. LBD10074-04-9 S. 5864 2
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) EVERY GROUP OR BLANKET POLICY DELIVERED OR ISSUED FOR DELIVERY IN THIS STATE THAT PROVIDES MEDICAL, MAJOR MEDICAL, OR SIMILAR COMPRE- HENSIVE-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 INTRAVENOUSLY ADMINISTERED OR INJECTED CANCER MEDICATIONS. S 4. Section 4303 of the insurance law is amended by adding a new subsection (q-1) to read as follows: (Q-1) EVERY POLICY 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 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 INTRAVENOUSLY ADMINISTERED OR INJECTED CANCER MEDICATIONS. S 5. This act shall take effect immediately and shall apply to poli- cies issued, modified, or renewed on or after such effective date.