BILL NUMBER: SB 961	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Wright
   (Coauthors: Senators Cox, Negrete McLeod, and Strickland)
   (Coauthor: Assembly Member Hall)

                        FEBRUARY 5, 2010

   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 961, as introduced, Wright. 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 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 prohibit health care service plan contracts and
health insurance policies that provide coverage for cancer
chemotherapy treatment that is taken orally from charging or
otherwise requiring a copayment or other charge for each of those
dispensed prescriptions in excess of a certain unspecified amount.
   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.  The Legislature finds and declares all of the
following:
   (a) There are 10 million Americans currently living with cancer.
   (b) Approximately 1.5 million new cases of cancer will be
diagnosed in the United States in 2010.
   (c) In California, 27, 725 men and 26, 735 women are expected to
die from cancer this year.
   (d) Nearly one out of every two Californians born today will
develop cancer at some point in their lives.
   (e) It is likely that one in five Californians will die of cancer.

   (f) It is the intent of the Legislature that a health plan or
insurer that includes on its formulary, or authorizes on the basis of
medical necessity, oral medications used to treat cancer shall not
require copayments or other charges for those medications at a level
that effectively makes the medication inaccessible to a patient.
  SEC. 2.  Section 1367.655 is added to the Health and Safety Code,
to read:
   1367.655.  A health care service plan contract issued, amended, or
renewed on or after January 1, 2011, that provides coverage for
chemotherapy treatment that is taken orally shall not charge or
otherwise require a copayment or other charge for each of those
dispensed prescriptions in excess of ____ dollars.
  SEC. 3.  Section 10123.205 is added to the Insurance Code, to read:

   10123.205.  A health insurance policy issued, amended, or renewed
on or after January 1, 2011, that provides coverage for chemotherapy
treatment that is taken orally shall not charge or otherwise require
a copayment or other charge for each of those dispensed prescriptions
in excess of ____ dollars.
  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.