HOUSE OF REPRESENTATIVES

H.B. NO.

1964

TWENTY-SIXTH LEGISLATURE, 2012

H.D. 1

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 chemotherapy, at the same or lower copayment percentage or relative coinsurance amount as is applied to intravenously administered chemotherapy; and which shall apply equally to generic and non-generic medications; 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 increase enrollee cost sharing for non-generic cancer medications to any greater extent than the policy increases enrollee cost sharing for other non-generic covered medication.

(b) For the purposes of this section:

"Cost share" or "cost sharing" means copayment, coinsurance, or deductible provisions applicable to coverage for oral, intravenous, or injected non-generic cancer medications.

["Intravenously administered chemotherapy"] "Intravenous or injected cancer medication" 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 chemotherapy, at the same or lower copayment percentage or relative coinsurance amount as is applied to intravenously administered chemotherapy; and shall apply equally to generic and non-generic medications; 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 increase enrollee cost sharing for non-generic cancer medications to any greater extent than the contract increases enrollee cost sharing for other non-generic covered medication.

(b) For the purposes of this section:

"Cost share" or "cost sharing" means copayment, coinsurance, or deductible provisions applicable to coverage for oral, intravenous, or injected non-generic cancer medications.

["Intravenously administered chemotherapy"] "Intravenous or injected cancer medication" 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.


 


 

Report Title:

Insurance; Chemotherapy

 

Description:

Limits out-of-pocket costs for cancer medications, including non-generic oral chemotherapy, under health insurance plans. (HB1964 HD1)

 

 

 

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