HLS 12RS-1012 ENGROSSED
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are additions.
Regular Session, 2012
HOUSE BILL NO. 693
BY REPRESENTATIVES CROMER, ADAMS, ANDERS, ARNOLD, BILLIOT,
BROSSETT, HENRY BURNS, DIXON, EDWARDS, HARRI SON, HAZEL,
HENRY, HUNTER, HUVAL, JOHNSON, JONES, KLECKLEY, TERRY
LANDRY, LEGER, LIGI, LOPINTO, LORUSSO, MONTOUCET, MORENO,
PIERRE, PONTI, PUGH, PYLANT, REYNOLDS, RICHARD, RICHARDSON,
RITCHIE, SCHRODER, SIMON, ST. GERMAIN, TALBOT, THIBAUT,
THIERRY, THOMPSON, AND WI LLMOTT AND SENATORS ALARI O,
AMEDEE, CHABERT, LAFLEUR, AND WHI TE
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 HLS 12RS-1012 ENGROSSED
HB NO. 693
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such medications, thus restricting patient access to life-saving oral anti-cancer1
medications. It is further declared that physicians must be able to make the best2
choice for their patients, considering the unique aspects of each patient and the3
progress of the disease.4
B.(1) A health insurance issuer that provides coverage for cancer treatment5
shall provide for coverage of prescribed orally administered anti-cancer medications6
on a basis no less favorable than intravenously administered or injected cancer7
medications.8
(2) Health insurance coverage of orally administered anti-cancer medications9
shall not be subject to any prior authorization, dollar limit, copayment, deductible,10
or other out-of-pocket expense that does not apply to intravenously administered or11
injected cancer medications, regardless of formulation or benefit category12
determination by the health insurance issuer.13
(3) A health insurance issuer shall not reclassify or increase any type of cost-14
sharing to the covered person for anti-cancer medications in order to achieve15
compliance with this Section. Any change in health insurance coverage that16
otherwise increases an out-of-pocket expense applied to anti-cancer medications17
shall also be applied to the majority of comparable medical or pharmaceutical18
benefits covered by the health insurance issuer.19
(4) A health insurance issuer that limits the total amount paid by a covered20
person through all cost-sharing requirements to no more than one hundred dollars per21
filled prescription for any orally administered anti-cancer medication shall be22
considered in compliance with this Section. For purposes of this Paragraph, "cost-23
sharing requirements" shall include copayments, coinsurance, deductibles, and any24
other amounts paid by the covered person for that prescription.25
C. As used in this Section:26
(1) "Anti-cancer medications" means medications used to kill or slow the27
growth of cancer cells.28 HLS 12RS-1012 ENGROSSED
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are additions.
(2) "Covered person" means a policyholder, subscriber, enrollee, or other1
individual enrolled in or insured by a health insurance issuer for health insurance2
coverage.3
(3) "Health insurance coverage" or "coverage" means benefits consisting of4
medical care provided or arranged for directly, through insurance or reimbursement,5
or through a network, and including services paid for as medical care under any6
hospital or medical service policy or certificate, hospital or medical service plan7
contract, preferred provider organization agreement, or health maintenance8
organization contract offered by a health insurance issuer.9
(4) "Health insurance issuer" means any entity that offers health insurance10
coverage through a policy or certificate of insurance subject to state law that11
regulates the business of insurance. For purposes of this Section, a "health insurance12
issuer" shall include a health maintenance organization, as defined and licensed13
pursuant to Subpart I of Part I of Chapter 2 of this Title, nonfederal government14
plans subject to the provisions of Subpart B of this Part, and the Office of Group15
Benefits.16
(5) "Network of providers" or "network" means an entity other than a health17
insurance issuer that, through contracts with health care providers, provides or18
arranges for access by groups of covered persons to covered health care services by19
health care providers who are not otherwise or individually contracted directly with20
a health insurance issuer.21
D. The provisions of this Section shall not apply to the following:22
(1) Individually underwritten, guaranteed renewable health insurance23
policies.24
(2) Limited benefit health insurance policies or contracts.25
(3) High deductible health plans or policies that are qualified to be used in26
conjunction with a health savings account, a medical savings account, or other27
similar program authorized by 26 U.S.C. 220 et seq.28
(4) Qualified health plans offered through a health benefit exchange.29 HLS 12RS-1012 ENGROSSED
HB NO. 693
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are additions.
Section 2. This Act shall be applicable to health insurance coverage that provides1
coverage for cancer treatment issued for delivery, delivered, renewed, or otherwise2
contracted for in this state on or after January 1, 2013.3
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
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. Provides that a health insurance issuer that
limits the total amount paid by a covered person through all cost-sharing requirements to no
more than $100 per filled prescription for any orally administered anti-cancer medication
shall be considered in compliance with proposed law.
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 individual policies, limited benefit policies,
certain high deductible plans, and qualified health plans offered through a health benefit
exchange. HLS 12RS-1012 ENGROSSED
HB NO. 693
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are additions.
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)
Summary of Amendments Adopted by House
Committee Amendments Proposed by House Committee on Insurance to the original
bill.
1. Added definition of "anti-cancer medications".
2. Added provisions that a health insurance issuer that limits the total amount
paid by a covered person through all cost-sharing requirements to no more
than $100 per filled prescription for any orally administered anti-cancer
medication shall be considered in compliance with proposed law.
3. Changed inapplicability from those individual and limited benefit policies
with the exception of those that cover cancer to individual policies, limited
benefit policies, certain high deductible health plans, and qualified health
plans offered through a health benefit exchange.