Florida Senate - 2013                                     SB 422
       
       
       
       By Senator Benacquisto
       
       
       
       
       30-00169A-13                                           2013422__
    1                        A bill to be entitled                      
    2         An act relating to cancer treatment; providing a short
    3         title; creating ss. 627.42391 and 641.313, F.S.;
    4         providing definitions; requiring that an individual or
    5         group insurance policy or contract or a health
    6         maintenance contract that provides coverage for cancer
    7         treatment medications provide coverage for orally
    8         administered cancer treatment medications on a basis
    9         no less favorable than that required by the policy or
   10         contract for intravenously administered or injected
   11         cancer treatment medications; prohibiting insurers,
   12         health maintenance organizations, and certain other
   13         entities from engaging in specified actions to avoid
   14         compliance with this act; providing a directive to the
   15         Division of Law Revision and Information; providing an
   16         effective date.
   17  
   18  Be It Enacted by the Legislature of the State of Florida:
   19  
   20         Section 1. This act may be cited as the “Cancer Treatment
   21  Fairness Act.”
   22         Section 2. Section 627.42391, Florida Statutes, is created
   23  to read:
   24         627.42391 Insurance policies; cancer treatment parity;
   25  orally administered cancer treatment medications.—
   26         (1) As used in this section, the term:
   27         (a) “Cancer treatment medication” means medication
   28  prescribed by a treating physician who determines that the
   29  medication is medically necessary to kill or slow the growth of
   30  cancerous cells in a manner consistent with nationally accepted
   31  standards of practice.
   32         (b) “Cost sharing” includes copayments, coinsurance, dollar
   33  limits, and deductibles imposed on the covered person.
   34         (2) An individual or group insurance policy delivered,
   35  issued for delivery, renewed, amended, or continued in this
   36  state that provides medical, major medical, or similar
   37  comprehensive coverage and includes coverage for cancer
   38  treatment medications must also cover prescribed, orally
   39  administered cancer treatment medications and may not apply
   40  cost-sharing requirements for orally administered cancer
   41  treatment medications that are less favorable to the covered
   42  person than cost-sharing requirements for intravenous or
   43  injected cancer treatment medications covered under the policy
   44  or contract.
   45         (3) An insurer providing a policy or contract described in
   46  subsection (2) and any participating entity through which the
   47  insurer offers health services may not:
   48         (a) Vary the terms of the policy in effect on the effective
   49  date of this act to avoid compliance with this section.
   50         (b) Provide any incentive, including, but not limited to, a
   51  monetary incentive, or impose treatment limitations to encourage
   52  a covered person to accept less than the minimum protections
   53  available under this section.
   54         (c) Penalize a health care practitioner or reduce or limit
   55  the compensation of a health care practitioner for recommending
   56  or providing services or care to a covered person as required
   57  under this section.
   58         (d) Provide any incentive, including, but not limited to, a
   59  monetary incentive, to induce a health care practitioner to
   60  provide care or services that do not comply with this section.
   61         (e) Change the classification of any intravenous or
   62  injected cancer treatment medication or increase the amount of
   63  cost sharing applicable to any intravenous or injected cancer
   64  treatment medication in effect on the effective date of this act
   65  in order to achieve compliance with this section.
   66         Section 3. Section 641.313, Florida Statutes, is created to
   67  read:
   68         641.313 Health maintenance contracts; cancer treatment
   69  parity; orally administered cancer treatment medications.—
   70         (1) As used in this section, the term:
   71         (a) “Cancer treatment medication” means medication
   72  prescribed by a treating physician who determines that the
   73  medication is medically necessary to kill or slow the growth of
   74  cancerous cells in a manner consistent with nationally accepted
   75  standards of practice.
   76         (b) “Cost sharing” includes copayments, coinsurance, dollar
   77  limits, and deductibles imposed on the covered person.
   78         (2) A health maintenance contract delivered, issued for
   79  delivery, renewed, amended, or continued in this state that
   80  provides medical, major medical, or similar comprehensive
   81  coverage and includes coverage for cancer treatment medications
   82  must also cover prescribed, orally administered cancer treatment
   83  medications and may not apply cost-sharing requirements for
   84  orally administered cancer treatment medications that are less
   85  favorable to the covered person than cost-sharing requirements
   86  for intravenous or injected cancer treatment medications covered
   87  under the contract.
   88         (3) A health maintenance organization providing a contract
   89  described in subsection (2) and any participating entity through
   90  which the health maintenance organization offers health services
   91  may not:
   92         (a) Vary the terms of the policy in effect on the effective
   93  date of this act to avoid compliance with this section.
   94         (b) Provide any incentive, including, but not limited to, a
   95  monetary incentive, or impose treatment limitations to encourage
   96  a covered person to accept less than the minimum protections
   97  available under this section.
   98         (c) Penalize a health care practitioner or reduce or limit
   99  the compensation of a health care practitioner for recommending
  100  or providing services or care to a covered person as required
  101  under this section.
  102         (d) Provide any incentive, including, but not limited to, a
  103  monetary incentive, to induce a health care practitioner to
  104  provide care or services that do not comply with this section.
  105         (e) Change the classification of any intravenous or
  106  injected cancer treatment medication or increase the amount of
  107  cost sharing applicable to any intravenous or injected cancer
  108  treatment medication in effect on the effective date of this act
  109  in order to achieve compliance with this section.
  110         Section 4. The Division of Law Revision and Information is
  111  directed to replace the phrase “the effective date of this act”
  112  wherever it occurs in this act with the date this act takes
  113  effect.
  114         Section 5. This act shall take effect July 1, 2013.