HLS 12RS-1012 ORIGINAL
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Regular Session, 2012
HOUSE BILL NO. 693
BY REPRESENTATIVES CROMER AND TALBOT AND SENATOR ALARI O
INSURANCE/HEALTH: Provides for parity for orally administered anti-cancer
medications
AN ACT1
To enact R.S. 22:999.1, relative to health insurance issuers which provide coverage for2
cancer treatment; to require that such issuers provide for parity for orally3
administered anti-cancer medications with intravenously administered or injected4
anti-cancer medications; to provide for definitions; to provide for applicability; and5
to provide for related matters.6
Be it enacted by the Legislature of Louisiana:7
Section 1. R.S. 22:999.1 is hereby enacted to read as follows:8
ยง999.1. Parity for orally administered anti-cancer medications with intravenously9
administered or injected anti-cancer medications10
A. It is hereby declared that the public policy of this state is that every11
person within this state with health insurance coverage that provides coverage for12
cancer treatment shall have access to the type of covered medication used to treat his13
cancer, as such a decision affects the person's overall, long-term health and quality14
of life. It is also declared that orally administered anti-cancer medications, although15
very effective in killing or slowing the growth of cancerous cells, have high out-of-16
pocket costs to the covered person, impacting the decision of physicians to prescribe17
such medications, thus restricting patient access to life-saving oral anti-cancer18
medications. It is further declared that physicians must be able to make the best19 HLS 12RS-1012 ORIGINAL
HB NO. 693
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choice for their patients, considering the unique aspects of each patient and the1
progress of the disease.2
B.(1) A health insurance issuer that provides coverage for cancer treatment3
shall provide for coverage of prescribed orally administered anti-cancer medications4
on a basis no less favorable than intravenously administered or injected cancer5
medications.6
(2) Health insurance coverage of orally administered anti-cancer medications7
shall not be subject to any prior authorization, dollar limit, copayment, deductible,8
or other out-of-pocket expense that does not apply to intravenously administered or9
injected cancer medications, regardless of formulation or benefit category10
determination by the health insurance issuer.11
(3) A health insurance issuer shall not reclassify or increase any type of cost-12
sharing to the covered person for anti-cancer medications in order to achieve13
compliance with this Section. Any change in health insurance coverage that14
otherwise increases an out-of-pocket expense applied to anti-cancer medications15
shall also be applied to the majority of comparable medical or pharmaceutical16
benefits covered by the health insurance issuer.17
C. As used in this Section:18
(1) "Covered person" means a policyholder, subscriber, enrollee, or other19
individual enrolled in or insured by a health insurance issuer for health insurance20
coverage.21
(2) "Health insurance coverage" or "coverage" means benefits consisting of22
medical care provided or arranged for directly, through insurance or reimbursement,23
or through a network, and including services paid for as medical care under any24
hospital or medical service policy or certificate, hospital or medical service plan25
contract, preferred provider organization agreement, or health maintenance26
organization contract offered by a health insurance issuer.27
(3) "Health insurance issuer" means any entity that offers health insurance28
coverage through a policy or certificate of insurance subject to state law that29 HLS 12RS-1012 ORIGINAL
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regulates the business of insurance. For purposes of this Section, a "health insurance1
issuer" shall include a health maintenance organization, as defined and licensed2
pursuant to Subpart I of Part I of Chapter 2 of this Title, nonfederal government3
plans subject to the provisions of Subpart B of this Part, and the Office of Group4
Benefits.5
(4) "Network of providers" or "network" means an entity other than a health6
insurance issuer that, through contracts with health care providers, provides or7
arranges for access by groups of covered persons to covered health care services by8
health care providers who are not otherwise or individually contracted directly with9
a health insurance issuer.10
E. The provisions of this Section shall not apply to the following with the11
exception of those which specifically cover cancer.12
(1) Individually underwritten, guaranteed renewable health insurance13
policies.14
(2) Limited benefit health insurance policies or contracts.15
Section 2. This Act shall be applicable to health insurance coverage that provides16
coverage for cancer treatment issued for delivery, delivered, renewed, or otherwise17
contracted for in this state on or after January 1, 2013.18
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
Cromer HB No. 693
Abstract: Provides for parity for orally administered anti-cancer medications with
intravenously administered or injected cancer medications by health insurance
issuers which provide coverage for cancer treatment.
Proposed law declares it to be the public policy of this state that every person within this
state with health insurance coverage that provides coverage for cancer treatment shall have
the right, with his physician, to the type of covered medication used to treat his cancer, as
such a decision affects the person's overall, long-term health and quality of life. Also
declares that orally administered anti-cancer medications, although very effective in killing
or slowing the growth of cancerous cells, have high out-of-pocket costs to the covered
person, impacting the decision of physicians to prescribe such medications, thus restricting
patient access to life-saving oral cancer medications. Further declares that physicians must HLS 12RS-1012 ORIGINAL
HB NO. 693
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are additions.
be able to make the best choice for their patients, considering the unique aspects of each
patient and the progress of the disease.
Proposed law provides that a health insurance issuer that provides coverage for cancer
treatment shall provide for coverage of prescribed orally administered anti-cancer
medications on a basis no less favorable than intravenously administered or injected cancer
medications. Also provides that health insurance coverage of orally administered anti-cancer
medications shall not be subject to any prior authorization, dollar limit, copayment,
deductible, or other out-of-pocket expense that does not apply to intravenously administered
or injected cancer medications, regardless of formulation or benefit category determination
by the health insurance issuer. Prohibits a health insurance issuer from reclassifying or
increasing any type of cost-sharing to the covered person for anti-cancer medications in
order to achieve compliance with proposed law. Also provides that any change in health
insurance coverage that otherwise increases an out-of-pocket expense applied to anti-cancer
medications shall also be applied to the majority of comparable medical or pharmaceutical
benefits covered by the health insurance issuer.
Proposed law specifies that it is applicable to health insurance issuers that provide coverage
for cancer treatment, including a health maintenance organization, certain nonfederal
government plans, and the Office of Group Benefits.
Proposed law specifies that it is not applicable to individually underwritten, guaranteed
renewable health insurance policies and limited benefit health insurance policies or contracts
with the exception of those which cover cancer.
Proposed law shall be applicable to health insurance coverage that provides coverage for
cancer treatment issued for delivery, delivered, renewed, or otherwise contracted for in this
state on or after Jan. 1, 2013.
(Adds R.S. 22:999.1)