BILL NUMBER: SB 161	AMENDED
	BILL TEXT

	AMENDED IN SENATE  MAY 14, 2009

INTRODUCED BY   Senator Wright
    (   Coauthor:   Senator   Alquist
  ) 

                        FEBRUARY 14, 2009

   An act to add Section 1367.655 to the Health and Safety Code, and
to add Section 10123.205 to the Insurance Code, relating to health
care coverage.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 161, as amended, Wright. Health care coverage: 
chemotherapy   cancer  treatment.
   Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires health care service plan contracts and health
insurance policies to provide coverage for all generally medically
accepted cancer screening tests and requires those plans and policies
to also provide coverage for the treatment of breast cancer.
Existing law imposes various requirements on contracts and policies
that cover prescription drug benefits.
   This bill would require health care service plan contracts and
health insurance policies that provide coverage for cancer
chemotherapy treatment to provide coverage for  a 
prescribed, orally administered  anticancer medications
  cancer medication  , as specified, on a basis no
less favorable than intravenously administered or injected cancer
medications covered under the contracts or policies.  The bill
would require a health care service plan or health insurer to review
the percentage cost share, as defined, for oral cancer medications
and intravenous or injected cancer medications and to apply the lower
of the 2 as the cost-   sharing provision for oral cancer
medications. 
   Because a willful violation of the bill's requirements relative to
health care service plans would be a crime, the bill would impose a
state-mandated local program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  Section 1367.655 is added to the Health and Safety
Code, to read:
   1367.655.   (a)    A health care service plan
contract issued, amended, or renewed on or after January 1, 2010,
that provides coverage for cancer chemotherapy treatment shall
provide coverage for a prescribed, orally administered cancer
medication used to kill or slow the growth of cancerous cells on a
basis no less favorable than intravenously administered or injected
cancer medications covered under the contract. 
   (b) In order to comply with subdivision (a), a health care service
plan shall review the percentage cost share for oral cancer
medications and intravenous or injected cancer medications and shall
apply the lower of the two as the cost-sharing provision for oral
cancer medications. A health care service plan contract shall not
provide for an increase in enrollee cost sharing for cancer
medications.  
   (c) For purposes of this section "cost share" means copayment,
coinsurance, or deductible provisions applicable to coverage for oral
or intravenous or injected cancer medications. 
  SEC. 2.  Section 10123.205 is added to the Insurance Code, to read:

   10123.205.   (a)    A health insurance policy
issued, amended, or renewed on or after January 1, 2010, that
provides coverage for cancer chemotherapy treatment shall provide
coverage for a prescribed, orally administered cancer medication used
to kill or slow the growth of cancerous cells on a basis no less
favorable than intravenously administered or injected cancer
medications covered under the policy. 
   (b) In order to comply with subdivision (a), a health insurer
shall review the percentage cost share for oral cancer medications
and intravenous or injected cancer medications and shall apply the
lower of the two as the cost-sharing provision for oral cancer
medications. A health insurance policy shall not provide for an
increase in insured cost sharing for cancer medications.  
   (c) For purposes of this section "cost share" means copayment,
coinsurance, or deductible provisions applicable to coverage for oral
or intravenous or injected cancer medications. 
  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.