Bill Text: NC H609 | 2013-2014 | Regular Session | Amended
Bill Title: NC Cancer Treatment Fairness Act
Spectrum: Bipartisan Bill
Status: (Engrossed - Dead) 2013-05-13 - Ref to Health Care. If fav, re-ref to Insurance [H609 Detail]
Download: North_Carolina-2013-H609-Amended.html
GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2013
H 4
HOUSE BILL 609
Committee Substitute Favorable 4/24/13
Committee
Substitute #2 Favorable 5/7/13
Fourth Edition Engrossed 5/9/13
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Short Title: NC Cancer Treatment Fairness Act. |
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April 9, 2013
A BILL TO BE ENTITLED
AN ACT relating to health benefit plan coverage for orally administered anticancer drugs.
Whereas, advances in medical research have led to significant new developments of various medical treatments; and
Whereas, these treatments offer patients a wide range of new choices to combat very serious diseases; and
Whereas, the area of cancer treatment has been one of the fields that has seen these significant new medical advancements; and
Whereas, in recent years, oral chemotherapy treatments have been developed that provide viable alternatives to traditional intravenous cancer treatments for patients; and
Whereas, this oral chemotherapy treatment offers the treating physician and the patient a choice in relation to treatment options; and
Whereas, this choice is sometimes limited as the oral chemotherapy treatments are in most cases covered under the prescription drug benefit of an insurance plan rather than under the major medical insurance benefit of an insurance plan; and
Whereas, 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; Now, therefore,
The General Assembly of North Carolina enacts:
SECTION 1. Article 3 of Chapter 58 of the General Statutes is amended by adding a new section to read as follows:
"§ 58‑3‑282. Coverage for orally administered anticancer drugs.
(a) Every health benefit plan offered by an insurer, as defined in G.S. 58‑3‑167(a), that provides coverage for prescribed, orally administered anticancer drugs that are used to kill or slow the growth of cancerous cells and that provides coverage for intravenously administered or injected anticancer drugs shall provide coverage for prescribed, orally administered anticancer drugs on a basis no less favorable than the coverage the policy, contract, or plan provides for the intravenously administered or injected anticancer drugs.
(b) Coverage for orally administered anticancer drugs shall not be subject to any prior authorization, dollar limit, co‑payment, coinsurance, or deductible provision or to any other out‑of‑pocket expense that does not apply to intravenously administered or injected anticancer drugs.
(c) A policy, contract, or plan provider shall not achieve compliance with this section by reclassifying anticancer drugs or by increasing patient cost‑sharing, including any coinsurance, co‑payment, deductible, or other out‑of‑pocket expenses imposed on anticancer drugs. Any policy, contract, or plan change that otherwise increases an out‑of‑pocket expense applied to anticancer drugs must also be applied to the majority of comparable medical or pharmaceutical benefits covered by the policy, contract, or plan.
(d) An insurer that limits the total amount paid by a covered person through all in‑network, cost‑sharing requirements to no more than three hundred dollars ($300.00) per filled prescription for any orally administered anticancer drug shall be considered in compliance with this section. For purposes of this subsection, "cost‑sharing requirements" shall include co‑payments, coinsurance, and deductibles, except in regard to a high deductible health plan or policy that is qualified to be used in conjunction with a health savings account, a medical savings account, or other similar program authorized by 26 U.S.C. § 220, et seq."
SECTION 2. This act becomes effective January 1, 2015, and applies to insurance contracts or policies issued, renewed, or amended on or after that date, but the act shall not become effective if the act is determined by the federal government to create a state‑required benefit that is in excess of the essential health benefits pursuant to 45 C.F.R. 155.170(a)(3).
