BILL NUMBER: SB 961 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 25, 2010
PASSED THE ASSEMBLY AUGUST 23, 2010
AMENDED IN ASSEMBLY JUNE 10, 2010
AMENDED IN SENATE APRIL 27, 2010
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 and repeal Section 1367.655 of the Health and Safety
Code, and to add and repeal Section 10123.205 of the Insurance Code,
relating to health care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 961, 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, until January 1, 2015, 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, nongeneric cancer medication, as
specified. The bill would require a health care service plan or
health insurer to review the percentage cost share, as defined, for
oral nongeneric cancer medications and intravenous or injected
nongeneric cancer medications and to apply the lower of the 2 as the
cost-sharing provision for oral nongeneric cancer medications. The
bill would limit increases in cost sharing for nongeneric cancer
medications, as specified. The bill would specify that its provisions
do not apply to health care service plan contracts or health
insurance policies that do not provide coverage for prescription
drugs. 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.
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, 2011, that provides
coverage for cancer chemotherapy treatment shall provide coverage for
a prescribed, orally administered, nongeneric cancer medication used
to kill or slow the growth of cancerous cells and shall review the
percentage cost share for oral nongeneric cancer medications and
intravenous or injected nongeneric cancer medications and apply the
lower of the two as the cost-sharing provision for oral nongeneric
cancer medications. A health care service plan contract shall not
provide for an increase in enrollee cost sharing for nongeneric
cancer medications to any greater extent than the contract provides
for an increase in enrollee cost sharing for other nongeneric covered
medications.
(b) For purposes of this section, "cost share" means copayment,
coinsurance, or deductible provisions applicable to coverage for
oral, intravenous, or injected nongeneric cancer medications.
(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) Nothing in this section shall prohibit a health care service
plan from removing a prescription drug from its formulary of covered
prescription drugs.
(e) This section shall not apply to a health care service plan
contract that does not provide coverage for prescription drugs.
(f) 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).
(g) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date.
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, 2011, that provides coverage for
cancer chemotherapy treatment shall provide coverage for a
prescribed, orally administered, nongeneric cancer medication used to
kill or slow the growth of cancerous cells and shall review the
percentage cost share for oral nongeneric cancer medications and
intravenous or injected nongeneric cancer medications and apply the
lower of the two as the cost-sharing provision for oral nongeneric
cancer medications. A health insurance policy shall not provide for
an increase in insured cost sharing for nongeneric cancer medications
to any greater extent than the policy provides for an increase in an
insured's cost sharing for other nongeneric covered medications.
(b) For purposes of this section, "cost share" means copayment,
coinsurance, or deductible provisions applicable to coverage for
oral, intravenous, or injected nongeneric cancer medications.
(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) Nothing in this section shall prohibit a health insurer from
removing a prescription drug from its formulary of covered
prescription drugs.
(e) This section shall not apply to a health insurance policy that
does not provide coverage for prescription drugs.
(f) 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).
(g) This section shall remain in effect only until January 1,
2015, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2015, deletes or extends
that date.
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.