[First Reprint]

SENATE, No. 1834

STATE OF NEW JERSEY

214th LEGISLATURE

 

INTRODUCED MARCH 22, 2010

 


 

Sponsored by:

Senator  LORETTA WEINBERG

District 37 (Bergen)

Senator  NIA H. GILL

District 34 (Essex and Passaic)

Assemblywoman  VALERIE VAINIERI HUTTLE

District 37 (Bergen)

Assemblywoman  LINDA R. GREENSTEIN

District 14 (Mercer and Middlesex)

Assemblywoman  NANCY F. MUNOZ

District 21 (Essex, Morris, Somerset and Union)

Assemblyman  RUBEN J. RAMOS, JR.

District 33 (Hudson)

 

Co-Sponsored by:

Senators Buono, Cardinale, Allen, Assemblywoman Angelini and Assemblyman O'Donnell

 

 

 

 

SYNOPSIS

     Requires health insurers to cover oral anticancer medications on no less favorable basis than intravenous anticancer medications.

 

CURRENT VERSION OF TEXT

     As reported by the Senate Commerce Committee on September 19, 2011, with amendments.

  


An Act concerning health benefits coverage for oral 1[cancer] anticancer1 medications and 1[revising] supplementing1 various parts of statutory law.

 

     Be It Enacted by the Senate and General Assembly of the State of New Jersey:

 

     1.    1a.1  A hospital service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1938, c.366 (C.17:48-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells 1[under the same terms and conditions as] on a basis no less favorable than1 the contract provides for intravenously administered or injected 1[cancer] anticancer1 medications.  1[The contract shall also provide coverage for expenses for medically necessary medications, such as medications that maintain red or white cell counts and treat nausea, that support the orally administered anticancer medications, under the same terms and conditions as the contract provides for intravenously administered or injected cancer medications]

     b.    Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.

     c.     A hospital service corporation contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act1.

     1d.1  This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.

 

     2.    1a.1  A medical service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1940, c.74 (C.17:48A-1 et seq.), or approved for issuance or renewal in this
State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells 1[under the same terms and conditions as] on a basis no less favorable than1 the contract provides for intravenously administered or injected 1[cancer] anticancer1 medications.  1[The contract shall also provide coverage for expenses for medically necessary medications, such as medications that maintain red or white cell counts and treat nausea, that support the orally administered anticancer medications, under the same terms and conditions as the contract provides for intravenously administered or injected cancer medications]  

     b.    Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.

     c.     A medical service corporation contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act1.

     1d.1 This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.

 

     3.    1a.1 A health service corporation contract that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to P.L.1985, c.236 (C.17:48E-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells 1[under the same terms and conditions as] on a basis no less favorable than1 the contract provides for intravenously administered or injected 1[cancer] anticancer1 medications.  1[The contract shall also provide coverage for expenses for medically necessary medications, such as medications that maintain red or white cell counts and treat nausea, that support the orally administered anticancer medications, under the same terms and conditions as the contract provides for intravenously administered or injected cancer medications] 

     b.    Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.

     c.     A health service corporation contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act1.

     1d.1 This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.

 

     4.    1a.1 An individual health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to N.J.S.17B:26-1 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells 1[under the same terms and conditions as] on a basis no less favorable than1 the policy provides for intravenously administered or injected 1[cancer] anticancer1 medications.  1[The policy shall also provide coverage for expenses for medically necessary medications, such as medications that maintain red or white cell counts and treat nausea, that support the orally administered anticancer medications, under the same terms and conditions as the policy provides for intravenously administered or injected cancer medications]

     b.  Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.

     c.  An individual health insurance policy shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the policy as of the effective date of this act1.

     1d.1 This section shall apply to those policies in which the insurer has reserved the right to change the premium.

 

     5.    1a.1 A group health insurance policy that provides hospital and medical expense benefits and is delivered, issued, executed, or renewed in this State pursuant to N.J.S.17B:27-26 et seq., or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells 1[under the same terms and conditions as] on a basis no less favorable than1 the policy provides for intravenously administered or injected 1[cancer] anticancer1 medications. 1[The policy shall also provide coverage for expenses for medically necessary medications, such as medications that maintain red or white cell counts and treat nausea, that support the orally administered anticancer medications, under the same terms and conditions as the policy provides for intravenously administered or injected cancer medications]

     b.    Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.

     c.     A group health insurance policy shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the policy as of the effective date of this act1.

     1d.1 This section shall apply to those policies in which the insurer has reserved the right to change the premium.

 

     6.    1a.1 An individual health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells 1[under the same terms and conditions as] on a basis no less favorable than1 the plan provides for intravenously administered or injected 1[cancer] anticancer1 medications. 1[The health benefits plan shall also provide coverage for expenses for medically necessary medications, such as medications that maintain red or white cell counts and treat nausea, that support the orally administered anticancer medications, under the same terms and conditions as the plan provides for intravenously administered or injected cancer medications]

     b.    Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.

     c.     An individual health benefits plan shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the plan as of the effective date of this act 1.

     1d.1 This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.

 

     7.    1a.1  A small employer health benefits plan that is delivered, issued, executed, or renewed in this State pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), on or after the effective date of this act, shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells 1[under the same terms and conditions as] on a basis no less favorable than1 the plan provides for intravenously administered or injected 1[cancer] anticancer1 medications. 1[The health benefits plan shall also provide coverage for expenses for medically necessary medications, such as medications that maintain red or white cell counts and treat nausea, that support the orally administered anticancer medications, under the same terms and conditions as the plan provides for intravenously administered or injected cancer medications

     b.    Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.

     c.     A small employer health benefits plan shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the plan as of the effective date of this act 1.

     1d.1 This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.

 

     8.    1a.1  A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide health care services for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells 1[under the same terms and conditions as] on a basis no less favorable than1 the contract provides for covered intravenously administered or injected 1[cancer] anticancer1 medications.  1[The contract shall also provide coverage for expenses for medically necessary medications, such as medications that maintain red or white cell counts and treat nausea, that support the orally administered anticancer medications, under the same terms and conditions as the contract provides for intravenously administered or injected cancer medications] 

     b.    Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.

     c.     A health maintenance organization contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act 1.

     1d.1  This section shall apply to those contracts for health care services under which the right to change the schedule of charges for enrollee coverage is reserved.

 

     9.    1a.1  The State Health Benefits Commission shall ensure that every contract purchased on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells 1[under the same terms and conditions as] on a basis no less favorable than1  the contract provides for intravenously administered or injected 1[cancer] anticancer1 medications.  1[The contract shall also provide coverage for expenses for medically necessary medications, such as medications that maintain red or white cell counts and treat nausea, that support the orally administered anticancer medications, under the same terms and conditions as the contract provides for intravenously administered or injected cancer medications] 

     b.    Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.

     c.     A State Health Benefits Commission contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act 1.

 

     10.  1a.1  The School Employees’ Health Benefits Commission shall ensure that every contract purchased on or after the effective date of this act that provides hospital or medical expense benefits shall provide coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells 1[under the same terms and conditions as] on a basis no less favorable than1 the contract provides for intravenously administered or injected 1[cancer] anticancer1 medications.  1[The contract shall also provide coverage for expenses for medically necessary medications, such as medications that maintain red or white cell counts and treat nausea, that support the orally administered anticancer medications, under the same terms and conditions as the contract provides for intravenously administered or injected cancer medications.]

     b.    Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.

     c.     A School Employees’ Health Benefits Commission contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act 1.

 

     11.  This act shall take effect on the 180th day after enactment and shall apply to all contracts and policies issued on or after the effective date.