AN ACT RELATING TO HEALTH BENEFIT PLAN COVERAGE FOR ORALLY ADMINISTERED ANTICANCER DRUGS.
Identical to H 306, filed 3/18/15.
Enacts new GS 58-3-282, concerning coverage for certain anticancer drugs, applicable to every health benefit plan offered by an insurer that provides coverage for prescribed, orally administered anticancer drugs that are used to kill or slow the growth of cancerous cells and that provides coverage for intravenously administered or injected anticancer drugs, requiring that such plans must provide coverage for prescribed, orally administered anticancer drugs on a basis no less favorable than the coverage provided for the intravenously administered or injected anticancer drug.
Prohibits coverage for orally administered anticancer drugs from being subject to prior authorization, dollar limit, co-payment, coinsurance, deductible provision, or any other out-of-pocket expense that does not apply to intravenously administered or injected anticancer drugs.
Prohibits achieving compliance by reclassifying drugs or increasing cost-sharing expenses imposed on anticancer drugs. Provides that if out-of-pocket expenses are increased for anticancer drugs then the same must also be applied to the majority of comparable medical or pharmaceutical benefits of the policy, contract, or plan.
Applies to insurance contracts issued, renewed, or amended on or after January 1, 2016. However, provides that it does not become effective if the act is determined by the federal government to create a state-required benefit that is in excess of the essential health benefits pursuant to 45 CFR 155.170(a)(3).
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