THE SENATE	S.B. NO.	2087
TWENTY-SIXTH LEGISLATURE, 2012
STATE OF HAWAII

A BILL FOR AN ACT

relating to HEALTH.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

     SECTION 1.  Section 431:10A-126, Hawaii Revised Statutes, is amended to read as follows:

     "[[]§431:10A‑126[]]  Chemotherapy services.  (a)  Notwithstanding section 23-51, all individual and group accident and health or sickness insurance policies that include coverage or benefits for the treatment of cancer shall provide payment or reimbursement for all chemotherapy that is considered medically necessary as defined in section 432E-1.4, including [orally administered] nongeneric, oral chemotherapy, [at the same copayment percentage or relative coinsurance amount as is applied to intravenously administered chemotherapy;] with a percentage cost share that is equal to the percentage cost share for orally administered, nongeneric cancer medications or the percentage cost share for intravenous or injected, nongeneric cancer medications, whichever is lower; provided that this section shall not apply to an accident only, specified disease, hospital indemnity, long-term care, or other limited benefit health insurance policy.  Individual and group accident and health or sickness insurance policies shall not provide for an increase in enrollee cost sharing for nongeneric cancer medications to any greater extent than the policy provides for an increase in enrollee cost sharing for other nongeneric covered medication.

     (b)  For the purposes of this section:

"Cost share" means copayment, coinsurance, or deductible provisions applicable to coverage for oral, intravenous, or injected nongeneric cancer medications.

     "Intravenously administered chemotherapy" means a physician-prescribed cancer treatment that is administered through injection directly into the patient's circulatory system by a physician, physician assistant, nurse practitioner, nurse, or other medical personnel under the supervision of a physician and in a hospital, medical office, or other clinical setting.

     "Oral chemotherapy" means a United States Food and Drug Administration-approved, physician-prescribed cancer treatment that is taken orally in the form of a tablet or capsule and may be administered in a hospital, medical office, or other clinical setting or may be delivered to the patient for self-administration under the direction or supervision of a physician outside of a hospital, medical office, or other clinical setting."

     SECTION 2.  Section 432:1-616, Hawaii Revised Statutes, is amended to read as follows:

     "[[]§432:1-616[]]  Chemotherapy services.  (a)  All individual and group hospital and medical service plan contracts that include coverage or benefits for the treatment of cancer shall provide payment or reimbursement for all chemotherapy that is considered medically necessary as defined in section 432E-1.4, including [orally administered] nongeneric, oral chemotherapy, [at the same copayment percentage or relative coinsurance amount as is applied to intravenously administered chemotherapy;] with a percentage cost share that is equal to the percentage cost share for orally administered, nongeneric cancer medications or the percentage cost share for intravenous or injected, nongeneric cancer medications, whichever is lower;

provided that this section shall not apply to an accident only, specified disease, hospital indemnity, long-term care, or other limited benefit health insurance policy.  Individual and group hospital and medical service plan contracts shall not provide for an increase in enrollee cost sharing for nongeneric cancer medications to any greater extent than the contract provides for an increase in enrollee cost sharing for other nongeneric covered medication.

     (b)  For the purposes of this section:

"Cost share" means copayment, coinsurance, or deductible provisions applicable to coverage for oral, intravenous, or injected nongeneric cancer medications.

     "Intravenously administered chemotherapy" means a physician-prescribed cancer treatment that is administered through injection directly into the patient's circulatory system by a physician, physician assistant, nurse practitioner, nurse, or other medical personnel under the supervision of a physician and in a hospital, medical office, or other clinical setting.

     "Oral chemotherapy" means a United States Food and Drug Administration-approved, physician-prescribed cancer treatment that is taken orally in the form of a tablet or capsule and may be administered in a hospital, medical office, or other clinical setting or may be delivered to the patient for self-administration under the direction or supervision of a physician outside of a hospital, medical office, or other clinical setting."

     SECTION 3.  Statutory material to be repealed is bracketed and stricken.  New statutory material is underscored.

     SECTION 4.  This Act shall take effect upon its approval.

INTRODUCED BY:

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Report Title:

Insurance; Chemotherapy

Description:

Requires health plans that provide coverage for cancer chemotherapy treatment to establish limits on out-of-pocket costs for cancer medications, including nongeneric, oral chemotherapy.

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.