BILL NUMBER: SB 961 AMENDED
BILL TEXT
AMENDED IN SENATE MARCH 9, 2010
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 amended, 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
orally administered cancer medications from charging a
copay ment for the medications in excess of 200% of the
lowest copayment required by the plan or policy for brand name
medications in the formulary of the plan or policy, as specified. The
bill would specify that its provisions do not apply to a health care
benefit plan, contract, or health insurance policy with the Board of
Administration of the Public Employees' Retirement System .
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) 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. orally administered cancer medication
used to kill or slow the growth of cancerous cells shall not charge a
copayment for these medications in excess of 200 percent of the
lowest copayment required by the plan for brand name
medications in the plan's formu lary.
(b) Nothing in this section shall prohibit a health care service
plan contract from requiring prior approval or authorization for the
use of any medication described in subdivision (a). However, if the
health care service plan contract authorizes the dispensing of the
medication for any reason, the copayment provisions of subdivision
(a) shall apply.
(c) Nothing in this section shall be construed to require a health
care service plan contract to provide coverage for any additional
medication not otherwise required by law.
(d) This section shall not apply to a health care benefit plan or
contract entered into with the Board of Administration of the Public
Employees' Retirement System pursuant to the Public Employees'
Medical and Hospital Care Act (Part 5 (commencing with Section 22750)
of Division 5 of Title 2 of the Government Code).
SEC. 3. 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, 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. orally administered cancer medication used to
kill or slow the growth of cancerous cells shall not charge a
copayment for these medications in excess of 200 percent of the
lowest copayment required by the policy for brand name
medications in the policy's formulary.
(b) Nothing in this section shall prohibit a health insurance
policy from requiring prior approval or authorization for the use of
any medication described in subdivision (a). However, if the policy
authorizes the dispensing of the medication for any reason, the
copayment provisions of subdivision (a) shall apply.
(c) Nothing in this section shall be construed to require a health
insurance policy to provide coverage for any additional medication
not otherwise required by law.
(d) This section shall not apply to a policy of health insurance
purchased by the Board of Administration of the Public Employees'
Retirement System pursuant to the Public Employees' Medical and
Hospital Care Act (Part 5 (commencing with Section 22750) of Division
5 of Title 2 of the Government Code).
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.