Requires coverage of orally administered chemotherapy treatments

16 Co-sponsors

• Ruth Hassell-Thompson
• James S. Alesi
• Eric Adams
• Joseph P. Addabbo Jr.
• Tony Avella
• John A. DeFrancisco
• Ruben Diaz
• Martin J. Golden
• Mark Grisanti
• Timothy M. Kennedy
• Jeffrey D. Klein
• Liz Krueger
• William J. Larkin Jr.
• Jack M. Martins
• George D. Maziarz
• Suzi Oppenheimer

BILL NUMBER:S3988B

Title of bill

An act to amend the insurance law, in relation to policy coverage of chemotherapy treatment

Purpose

To require health insurance plans in New York to cover orally administered chemotherapy treatment no less favorably than intravenously administered or injected chemotherapy treatments.

Summary of provisions

Section one is the legislative intent.

Section two amends subsection (i) of section 3216 of the insurance law by adding a new paragraph 12-a.

Section three amends subsection 3221 of the insurance law by adding a new paragraph 12-a.

Section four Amends section 4303 of the insurance law by adding a new subsection (q-1).

Section five is the effective date.

Justification

Medical advances over the years have led to many beneficial medical treatments. One of these medical advances has been the development of an oral chemotherapy treatment. With this treatment, a patient is able to undergo chemotherapy by taking a pill in the comfort of their own home. This means that the patient does not have to go to the hospital for the traditional intravenous or injectable form of chemotherapy that is most commonly thought of when chemotherapy is discussed. In addition to being able to do the treatment in their own home, the patient also receives the added benefit of possibly not having the traditionally chemotherapy side effects such as hair loss and the patient also sleeps through the treatment as the pill is administered at bedtime, meaning that the patient sleeps while the drugs do their work.

This medical advance is significant. However, due to a classification by insurance companies, many patients cannot reap the benefits of this advance. As this chemotherapy treatment comes in the form of a pill, insurance companies are classifying this treatment as a prescription drug treatment. This means that the patient does not get the treatment covered as a traditional chemotherapy treatment and must pay for the drug as though it were an average prescription drug. As this is not an average prescription drug, the co-pay and coverage for this drug are limited. Most patients must payout of pocket in the highest drug price category. This means that for the majority of patients, the pill form of chemotherapy will cost tens of thousands of dollars. This is obviously cost prohibitive and limits patient access to a viable and desirable alternative to traditional chemotherapy treatment.

Traditional chemotherapy treatment is usually covered under the major medical benefits, and once the deductible is met, if there even is one, the treatment is 100% covered. This amendment to the New York State Insurance Law would correct this discrepancy and ensure that chemotherapy treatment, no matter how administered, is covered equally by insurance companies.

Legislative history

2010: S.4516 - Referred to Insurance. 2009: S.4516 - Referred to Insurance.

Fiscal implications

None.

Effective date

This law would take effect on the first of January next succeeding the date on which it shall become a law and shall apply to all policies and contracts issued, renewed, modified, altered or amended after the effective date.