Bill Text: OH HB237 | 2009-2010 | 128th General Assembly | Introduced

Ohio House Bill 237 (Prior Session Legislation)

Introduced

Bill Title: Regarding health insurance coverage for orally administered cancer medications and the procedures insured persons are required or permitted to use in acquiring certain non-self-injectable and compounded medications.

Spectrum: Strong Partisan Bill (Democrat 14-1)

Status: (Introduced - Dead) 2009-06-23 - To Healthcare Access & Affordability [HB237 Detail]

Download: Ohio-2009-HB237-Introduced.html

As Introduced

128th General Assembly

Regular Session

2009-2010

H. B. No. 237

Representative Newcomb

Cosponsors: Representatives Fende, Weddington, Hagan, Harwood, Boyd, Phillips, Domenick, Letson, Moran, Yuko, Winburn, Luckie, Harris, Bolon

A BILL

To amend section 1739.05 and to enact sections

1751.68, 1751.69, 3923.84, and 3923.85, of the

Revised Code regarding health insurance coverage

for orally administered cancer medications and

the procedures insured persons are required or

permitted to use in acquiring certain

non-self-injectable and compounded medications.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF OHIO:

Section 1. That section 1739.05 be amended and sections	8
1751.68, 1751.69, 3923.84, and 3923.85 of the Revised Code be	9
enacted to read as follows:	10

Sec. 1739.05. (A) A multiple employer welfare arrangement	11
that is created pursuant to sections 1739.01 to 1739.22 of the	12
Revised Code and that operates a group self-insurance program may	13
be established only if any of the following applies:	14

(1) The arrangement has and maintains a minimum enrollment of	15
three hundred employees of two or more employers.	16

(2) The arrangement has and maintains a minimum enrollment of	17
three hundred self-employed individuals.	18

(3) The arrangement has and maintains a minimum enrollment of	19
three hundred employees or self-employed individuals in any	20
combination of divisions (A)(1) and (2) of this section.	21

(B) A multiple employer welfare arrangement that is created	22
pursuant to sections 1739.01 to 1739.22 of the Revised Code and	23
that operates a group self-insurance program shall comply with all	24
laws applicable to self-funded programs in this state, including	25
sections 3901.04, 3901.041, 3901.19 to 3901.26, 3901.38, 3901.381	26
to 3901.3814, 3901.40, 3901.45, 3901.46, 3902.01 to 3902.14,	27
3923.282, 3923.30, 3923.301, 3923.38, 3923.581, 3923.63, 3923.80,	28
3923.84, 3923.85, 3924.031, 3924.032, and 3924.27 of the Revised	29
Code.	30

(C) A multiple employer welfare arrangement created pursuant	31
to sections 1739.01 to 1739.22 of the Revised Code shall solicit	32
enrollments only through agents or solicitors licensed pursuant to	33
Chapter 3905. of the Revised Code to sell or solicit sickness and	34
accident insurance.	35

(D) A multiple employer welfare arrangement created pursuant	36
to sections 1739.01 to 1739.22 of the Revised Code shall provide	37
benefits only to individuals who are members, employees of	38
members, or the dependents of members or employees, or are	39
eligible for continuation of coverage under section 1751.53 or	40
3923.38 of the Revised Code or under Title X of the "Consolidated	41
Omnibus Budget Reconciliation Act of 1985," 100 Stat. 227, 29	42
U.S.C.A. 1161, as amended.	43

Sec. 1751.68. (A) Notwithstanding section 3901.71 of the	44
Revised Code and subject to division (B) of this section, no	45
individual or group health insuring corporation policy, contract,	46
or agreement providing basic health care services or prescription	47
drug services that is delivered, issued for delivery, or renewed	48
in this state on or after the effective date of this section and	49
that provides coverage for cancer chemotherapy treatment shall	50
provide coverage for a prescribed, orally administered cancer	51
medication on a less favorable basis than coverage for	52
intravenously administered or injected cancer medications.	53

(B) The prohibition in division (A) of this section includes	54
a prohibition on imposing a coverage limit, copayment, or	55
deductible that is greater, or a prior authorization requirement	56
that is more stringent, than any coverage limit, copayment,	57
deductible, or prior authorization requirement in the policy,	58
contract, or agreement that applies to coverage for intravenously	59
administered or injected cancer medications.	60

Sec. 1751.69. (A) As used in this section:

(1) "Dangerous drug" and "pharmacy" have the same meanings	62
as in section 4729.01 of the Revised Code.	63

(2) "Non-self-injectable medication" means a dangerous drug	64
intended for administration by injection that an individual cannot	65
reasonably self-administer.	66

(3) "Retail seller" has the same meaning as in section	67
4729.01 of the Revised Code, and includes a specialty pharmacy or	68
mail order pharmacy.	69

(B) No individual or group health insuring corporation	70
policy, contract, or agreement providing basic health care	71
services or prescription drug services that is delivered, issued	72
for delivery, or renewed in this state on or after the effective	73
date of this section and that provides coverage for	74
non-self-injectable medications, medications that must be	75
compounded immediately prior to administration, or both, shall do	76
either of the following:	77

(1) Require an enrollee to take possession of such a	78
medication from a pharmacy that is a retail seller;	79

(2) Give an enrollee the option of having such a medication	80
delivered directly to the enrollee by mail or any means of	81
commercial shipment.	82

Sec. 3923.84. (A) Notwithstanding section 3901.71 of the	83
Revised Code and subject to division (B) of this section, neither	84
of the following that provides coverage for cancer chemotherapy	85
treatment shall provide coverage for a prescribed, orally	86
administered cancer medication on a less favorable basis than for	87
intravenously administered or injected cancer medications:	88

(1) An individual or group policy of sickness and accident	89
insurance that is delivered, issued for delivery, or renewed in	90
this state on or after the effective date of this section;	91

(2) A public employee benefit plan that is established or	92
modified in this state on or after the effective date of this	93
section.	94

(B) The prohibition in division (A) of this section includes	95
a prohibition on imposing a coverage limit, copayment, or	96
deductible that is greater, or a prior authorization requirement	97
that is more stringent, than any coverage limit, copayment,	98
deductible, or prior authorization requirement in the policy or	99
plan that applies to coverage for intravenously administered or	100
injected cancer medications.	101

Sec. 3923.85. (A) As used in this section:

102

(1) "Dangerous drug" and "pharmacy" have the same meanings	103
as in section 4729.01 of the Revised Code.	104

(2) "Non-self-injectable medication" means a dangerous drug	105
intended for administration by injection that an individual cannot	106
reasonably self-administer.	107

(3) "Retail seller" has the same meaning as in section	108
4729.01 of the Revised Code, and includes a specialty pharmacy or	109
mail order pharmacy.	110

(B)Neither of the following that provides coverage for	111
non-self-injectable medications, medications that must be	112
compounded immediately prior to administration, or both, shall	113
require an insured to take possession of such a medication from a	114
pharmacy that is a retail seller or give an insured the option of	115
having such a medication delivered directly to the insured by mail	116
or any means of commercial shipment:	117

(1) An individual or group policy of sickness and accident	118
insurance that is delivered, issued for delivery, or renewed in	119
this state on or after the effective date of this section;	120