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Introduced Version House Bill 2493 History

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Key: Green = existing Code. Red = new code to be enacted

H. B. 2493

 

                        (By Delegates McCuskey, Westfall, Ashley, Bates, Ellington, Frich,

                                    Householder, Perdue, Sobonya, Walters and Rohrbach)


                        [Introduced January 28, 2015; referred to the

                        Committee on Banking and Insurance then Health and Human Resources.]

 

 

A BILL to amend the Code of West Virginia, 1931, as amended, by adding thereto a new section, designated §33-15-4l; to amend said code by adding thereto a new section, designated §33-16-3x; to amend said code by adding thereto a new section, designated §33-24-7m; to amend said code by adding thereto a new section, designated §33-25-8j; and to amend said code by adding thereto a new section, designated §33-25A-8l, all relating to requirements for insurance policies and contracts providing accident and sickness insurance or direct health care services that cover anti-cancer medications; prohibiting higher copayments, deductibles or coinsurance for orally administered anti-cancer medications than is required for anti-cancer medications administered by injection or intravenously; prohibiting certain acts to comply with the requirements; defining “anti-cancer medications”; providing an effective date of January 1, 2016; and allowing cost containment measures necessary to maintain costs of compliance to below two percent of the total costs for the coverage.

Be it enacted by the Legislature of West Virginia:

            That the Code of West Virginia, 1931, as amended, be amended by adding thereto a new section, designated §33-15-4l; that said code be amended by adding thereto a new section, designated §33-16-3x; that said code be amended by adding thereto a new section, designated §33-24-7m; that said code be amended by adding thereto a new section, designated §33-25-8j; and that said code be amended by adding thereto a new section, designated §33-25A-8l, all to read as follows:

ARTICLE 15. ACCIDENT AND SICKNESS INSURANCE.

§33-15-4l. Deductibles, copayments and coinsurance for anti-cancer medications.

            (a) Any accident and sickness insurance policy issued by an insurer pursuant to this article that covers anti-cancer medications that are injected or intravenously administered by a health care provider and patient administered anti-cancer medications, including, but not limited to, those medications orally administered or self-injected, may not require a higher copayment, deductible or coinsurance amount for patient administered anti-cancer medications than it requires for injected or intravenously administered anti-cancer medications, regardless of the formulation or benefit category determination by the policy or plan.

            (b) An accident or sickness insurance policy may not comply with subsection (a) of this section by:

            (1) Increasing the copayment, deductible or coinsurance amount required for injected or intravenously administered anti-cancer medications that are covered under the policy or plan; or

            (2) Reclassifying benefits with respect to anti-cancer medications.

            (c) As used in this section, “anti-cancer medication” means drugs and biologics that are used or administered to kill, slow or prevent the growth of cancerous cells.

            (d) This section is effective January 1, 2016. This section applies to all group accident and sickness insurance policies and plans subject to this article that are delivered, executed, issued, amended, adjusted or renewed in this state, or outside this state if insuring residents of this state, on and after the effective date of this section.

            (e) Notwithstanding any other provision in this section to the contrary, in the event that an insurer can demonstrate actuarially to the Insurance Commissioner that its total costs for compliance with this section will exceed or have exceeded two percent of the total costs for all accident and sickness insurance coverage issued by the insurer subject to this article in any experience period, then the insurer may apply whatever cost containment measures may be necessary to maintain costs below two percent of the total costs for the coverage: Provided, That the cost containment measures implemented are applicable only for the plan year or experience period following approval of the request to implement cost containment measures.

ARTICLE 16. GROUP ACCIDENT AND SICKNESS INSURANCE.

§33-16-3x. Deductibles, copayments and coinsurance for anti-cancer medications.            (a) Any group accident and sickness insurance policy issued by an insurer pursuant to this article that covers anti-cancer medications that are injected or intravenously administered by a health care provider and patient administered anti-cancer medications, including, but not limited to, those medications orally administered or self-injected, may not require a higher copayment, deductible or coinsurance amount for patient administered anti-cancer medications than it requires for injected or intravenously administered anti-cancer medications, regardless of the formulation or benefit category determination by the policy or plan.

            (b) A group accident and sickness insurance policy may not comply with subsection (a) of this section by:

            (1) Increasing the copayment, deductible or coinsurance amount required for injected or intravenously administered anti-cancer medications that are covered under the policy or plan; or

            (2) Reclassifying benefits with respect to anti-cancer medications.

            (c) As used in this section, “anti-cancer medication” means drugs and biologics that are used or administered to kill, slow or prevent the growth of cancerous cells.

            (d) This section is effective January 1, 2016. This section applies to all group accident and sickness insurance policies and plans subject to this article that are delivered, executed, issued, amended, adjusted or renewed in this state, or outside this state if insuring residents of this state, on and after the effective date of this section.

            (e) Notwithstanding any other provision in this section to the contrary, in the event that an insurer can demonstrate actuarially to the Insurance Commissioner that its total anticipated costs for any plan to comply with this section will exceed or have exceeded two percent of the total costs for such plan in any experience period, then the insurer may apply whatever cost containment measures may be necessary to maintain costs below two percent of the total costs for the plan: Provided, That such cost containment measures implemented are applicable only for the plan year following approval of the request to implement cost containment measures.

ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, DENTAL SERVICE CORPORATIONS AND HEALTH SERVICE CORPORATIONS.

§33-24-7m. Deductibles, copayments and coinsurance for anti-cancer medications.

            (a) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any group accident and sickness insurance policy, plan, contract or agreement issued by an entity regulated by this article that covers anti-cancer medications that are injected or intravenously administered by a health care provider and patient administered anti-cancer medications, including, but not limited to, those medications orally administered or self-injected, may not require a higher copayment, deductible or coinsurance amount for patient administered anti-cancer medications than it requires for injected or intravenously administered anti-cancer medications, regardless of the formulation or benefit category determination by the policy or plan.

            (b) An accident or sickness insurance policy, plan, contract or agreement may not comply with subsection (a) of this section by:

            (1) Increasing the copayment, deductible or coinsurance amount required for injected or intravenously administered anti-cancer medications that are covered under the policy or plan; or

            (2) Reclassifying benefits with respect to anti-cancer medications.

            (c) As used in this section, “anti-cancer medication” means drugs and biologics that are used or administered to kill, slow or prevent the growth of cancerous cells.

            (d) This section is effective January 1, 2016. This section applies to all group accident and sickness insurance policies and plans subject to this article that are delivered, executed, issued, amended, adjusted or renewed in this state, or outside this state if insuring residents of this state, on and after the effective date of this section.

            (e) Notwithstanding any other provision in this section to the contrary, in the event that an entity subject to this article can demonstrate actuarially to the Insurance Commissioner that its total anticipated costs for any policy, plan, contract or agreement to comply with this section will exceed or have exceeded two percent of the total costs for such policy, plan, contract or agreement in any experience period, then the entity may apply whatever cost containment measures may be necessary to maintain costs below two percent of the total costs for the policy, plan, contract or agreement: Provided, That such cost containment measures implemented are applicable only for the plan year or experience period following approval of the request to implement cost containment measures.

ARTICLE 25. HEALTH CARE CORPORATIONS.

§33-25-8j. Deductibles, copayments and coinsurance for anti-cancer medications.

            (a) Notwithstanding any provision of any policy, contract, plan or agreement to which this article applies, a policy, contract, plan or agreement issued to a member or subscriber by an entity regulated by this article that covers anti-cancer medications that are injected or intravenously administered by a health care provider and patient administered anti-cancer medications, including, but not limited to, those medications orally administered or self-injected, may not require a higher copayment, deductible or coinsurance amount for patient administered anti-cancer medications than it requires for injected or intravenously administered anti-cancer medications, regardless of the formulation or benefit category determination by the policy, contract, plan or agreement.

            (b) A contract issued to a member or subscriber that is subject to this article may not comply with subsection (a) of this section by:

            (1) Increasing the copayment, deductible or coinsurance amount required for injected or intravenously administered anti-cancer medications that are covered under the policy, contract, or plan or agreement; or

            (2) Reclassifying benefits with respect to anti-cancer medications.

            (c) As used in this section, “anti-cancer medication” means drugs and biologics that are used or administered to kill, slow or prevent the growth of cancerous cells.

            (d) This section is effective January 1, 2016. This section applies to all policies, plans, contracts or agreements subject to this article that are delivered, executed, issued, amended, adjusted or renewed in this state, or outside this state if insuring residents of this state, on and after the effective date of this section.

            (e) Notwithstanding any other provision in this section to the contrary, in the event that an entity subject to this article can demonstrate actuarially to the Insurance Commissioner that its total anticipated costs for benefits to all members or subscribers to comply with this section will exceed or have exceeded two percent of the total costs for all benefits of the policy, plan, contract or agreement in any experience period, then the entity may apply whatever cost containment measures may be necessary to maintain costs below two percent of the total costs for the policy, plan, contract or agreement: Provided, That such cost containment measures implemented are applicable only for the plan year or experience period following approval of the request to implement cost containment measures.

ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.

§33-25A-8l. Deductibles, copayments and coinsurance for anti-cancer medications.

            (a) Notwithstanding any provision of any policy, provision, contract, plan or agreement to which this article applies, any policy, contract, plan or agreement issued by a health maintenance organization pursuant to this article that covers anti-cancer medications that are injected or intravenously administered by a health care provider and patient administered anti-cancer medications, including, but not limited to, those medications orally administered or self-injected, may not require a higher copayment, deductible or coinsurance amount for patient administered anti-cancer medications than it requires for injected or intravenously administered anti-cancer medications, regardless of the formulation or benefit category determination by the policy, contract, plan or agreement.

            (b) A policy, contract, plan or agreement or a health maintenance organization may not comply with subsection (a) of this section by:

            (1) Increasing the copayment, deductible or coinsurance amount required for injected or intravenously administered anti-cancer medications that are covered under the policy, contract, or plan or agreement; or

            (2) Reclassifying benefits with respect to anti-cancer medications.

            (c) As used in this section, “anti-cancer medication” means drugs and biologics that are used or administered to kill, slow or prevent the growth of cancerous cells.

            (d) This section is effective January 1, 2016. This section applies to all policies, contracts, plans or agreements subject to this article that are delivered, executed, issued, amended, adjusted or renewed in this state, or outside this state if insuring residents of this state, on and after the effective date of this section.

            (e) Notwithstanding any other provision in this section to the contrary, in the event that a health maintenance organization subject to this article can demonstrate actuarially to the Insurance Commissioner that its total anticipated costs for any health maintenance contract to comply with this section will exceed or have exceeded two percent of the total costs for the policy, contract, plan or agreement in any experience period, then the health maintenance organization may apply whatever cost containment measures may be necessary to maintain costs below two percent of the total costs for the policy, contract, plan or agreement: Provided, That such cost containment measures implemented are applicable only for the plan year or experience period following approval of the request to implement cost containment measures.


            NOTE: The purpose of this bill is to prohibit insurance policies and contracts providing accident and sickness insurance or direct health care services that cover anti-cancer medications from charging higher copayments, deductibles or coinsurance for orally administered anti-cancer medications than is required for anti-cancer medications administered by injection or intravenously. Certain acts to comply with the requirements are prohibited; The requirements apply to policies or contracts that are issued or renewed after January 1, 2016. The bill also allows for cost containment measures if the cost of compliance exceeds two per cent of the total cost of coverage.


            §33-15-4l, §33-16-3x, §33-24-7m,§33-25-8j and §33-25A-8l are new; therefore they have been completely underscored.

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