BILL NUMBER: AB 219 AMENDED
BILL TEXT
AMENDED IN SENATE SEPTEMBER 4, 2013
AMENDED IN SENATE AUGUST 20, 2013
AMENDED IN SENATE JULY 2, 2013
AMENDED IN SENATE JUNE 19, 2013
AMENDED IN SENATE JUNE 17, 2013
INTRODUCED BY Assembly Member Perea
(Coauthors: Assembly Members Olsen, Wieckowski, and Williams)
(Coauthor: Senator Wright)
FEBRUARY 4, 2013
An act to add and repeal Section 1367.656 to
of the Health and Safety Code, and to add
and repeal Section 10123.206 to of
the Insurance Code, relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
AB 219, as amended, Perea. Health care coverage: 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 contracts 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 prohibit a an individual
or group health care service plan contract or health insurance
policy issued, amended, or renewed on or after January 1, 2015, that
provides coverage for prescribed, orally administered anticancer
medications from requiring an enrollee or insured to pay a
total cost-sharing amount of more than $100 per filled prescription.
The bill would provide that, with respect to a high deductible health
plan, as defined, this provision applies only if the plan deductible
has been satisfied. used to kill or slow the growth
of cancerous cells from requiring an enrollee or insured to pay,
notwithstanding any deductible, a total amount of copayments and
coinsurance that exceeds $200 for an individual prescription of up to
a 30-day supply of a prescribed orally administered anticancer
medication. The bill would provide that for a health care
service plan contract or health insurance policy that meets a
specified federal definition of a high deductible health plan, this
prohibition shall only apply once the enrollee's or insured's
deductible has been satisfied for the year. The bill would
authorize a health care service plan or health insurer, on January
1, 2016, and on January 1 of each year thereafter, to increase the
$200 limit by the percentage increase in the Consumer Price Index for
that year. The bill would repeal these provisions on January 1,
2019.
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. (a) The Legislature finds and declares
that the majority of prescriptions for oral anticancer medications
are filled by cancer patients at reasonable cost due to effective
health plan or health insurance coverage of the product or the low
retail price of the drug.
(b) It is the intent of the Legislature to help cancer patients
who do not have access to the most appropriate treatment for their
cancer because the terms of their health care service plan contract
or health insurance policy do not make the covered treatment
affordable.
(c) It is further the intent of the Legislature to set a maximum
total copayment and coinsurance amount that health care service plans
and health insurers can require patients to pay for a 30-day supply
of oral anticancer medication. The Legislature does not intend health
care service plans or health insurers to interpret that maximum to
be a target or desirable patient cost.
SEC. 2. Section 1367.656 is added to the
Health and Safety Code , to read:
1367.656. (a) Notwithstanding any other law, an individual or
group health care service plan contract issued, amended, or renewed
on or after January 1, 2015, that provides coverage for prescribed,
orally administered anticancer medications used to kill or slow the
growth of cancerous cells shall comply with all of the following:
(1) Notwithstanding any deductible, the total amount of copayments
and coinsurance an enrollee is required to pay shall not exceed two
hundred dollars ($200) for an individual prescription of up to a
30-day supply of a prescribed orally administered anticancer
medication covered by the contract.
(2) For a health care service plan contract that meets the
definition of a "high deductible health plan" set forth in Section
223(c)(2) of Title 26 of the United States Code, paragraph (1) shall
only apply once an enrollee's deductible has been satisfied for the
year.
(3) Paragraph (1) shall not apply to any coverage under a health
care service plan contract for the Medicare Program pursuant to Title
XVIII of the federal Social Security Act (42 U.S.C. Sec. 1395 et
seq.).
(4) On January 1, 2016, and on January 1 of each year thereafter,
health care service plans may adjust the two hundred dollar ($200)
limit described in paragraph (1). The adjustment shall not exceed the
percentage increase in the Consumer Price Index for that year.
(5) A prescription for an orally administered anticancer
medication shall be provided consistent with the appropriate standard
of care for that medication.
(b) This section shall remain in effect only until January 1,
2019, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2019, deletes or extends
that date.
SEC. 3. Section 10123.206 is added to the
Insurance Code , to read:
10123.206. (a) Notwithstanding any other law, an individual or
group health insurance policy issued, amended, or renewed on or after
January 1, 2015, that provides coverage for prescribed, orally
administered anticancer medications used to kill or slow the growth
of cancerous cells shall comply with all of the following:
(1) Notwithstanding any deductible, the total amount of copayments
and coinsurance an insured is required to pay shall not exceed two
hundred dollars ($200) for an individual prescription of up to a
30-day supply of a prescribed orally administered anticancer
medication covered by the policy.
(2) For a health insurance policy that meets the definition of a
"high deductible health plan" set forth in Section 223(c)(2) of Title
26 of the United States Code, paragraph (1) shall only apply once an
insured's deductible has been satisfied for the year.
(3) Paragraph (1) shall not apply to any coverage under a health
insurance policy for the Medicare Program pursuant to Title XVIII of
the federal Social Security Act (42 U.S.C. Sec. 1395 et seq.).
(4) On January 1, 2016, and on January 1 of each year thereafter,
health insurers may adjust the two hundred dollar ($200) limit
described in paragraph (1). The adjustment shall not exceed the
percentage increase in the Consumer Price Index for that year.
(5) A prescription for an orally administered anticancer
medication shall be provided consistent with the appropriate standard
of care for that medication.
(b) This section shall remain in effect only until January 1,
2019, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2019, deletes or extends
that date.
SEC. 4. 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.
SECTION 1. Section 1367.656 is added to the
Health and Safety Code, to read:
1367.656. (a) Notwithstanding any other law, a health care
service plan contract issued, amended, or renewed on or after January
1, 2015, that provides coverage for prescribed, orally administered
anticancer medications shall not require an enrollee to pay a total
cost-sharing amount of more than one hundred dollars ($100) per
filled prescription.
(b) The cost-sharing limit in this section shall not apply to a
health care service plan contract if the plan is a high deductible
health plan, as defined in Section 223 of Title 26 of the United
States Code, and the plan deductible has not been satisfied.
SEC. 2. Section 10123.206 is added to the
Insurance Code, to read:
10123.206. (a) Notwithstanding any other law, a health insurance
policy issued, amended, or renewed on or after January 1, 2015, that
provides coverage for prescribed, orally administered anticancer
medications shall not require an insured to pay a total cost-sharing
amount of more than one hundred dollars ($100) per filled
prescription.
(b) The cost-sharing limit in this section shall not apply to a
health insurance policy if the policy is a high deductible health
plan, as defined in Section 223 of Title 26 of the United States
Code, and the policy deductible has not been satisfied.
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.