1517 AMH JINK MORI 025

HB 1517 - H AMD 223

By Representative Jinkins

ADOPTED 03/04/2011

    Strike everything after the enacting clause and insert the following:

"NEW SECTION.  Sec. 1. The Washington state legislature finds that for cancer patients, there is an inequity in how much they have to pay toward the cost of a self administered oral medication and how much they have to pay for an intravenous product that is administered in a physician's office or clinic.  The legislature further finds that when these inequities exist, patients' access to medically necessary, appropriate treatment is often unfairly restricted.  The legislature also acknowledges that self administered chemotherapy is the only treatment for some types of cancer where there is no intravenous alternative.  The legislature declares that in order to reduce the out-of-pocket costs for cancer patients whose diagnosis requires treatment through self administered anticancer medication, the cost-sharing responsibilities for these patients must be on a basis at least comparable to those of patients receiving intravenously administered anticancer medication.

NEW SECTION.  Sec. 2. A new section is added to chapter 41.05 RCW to read as follows:

    (1) Each health plan offered to public employees and their covered dependents under this chapter, including those subject to the provision of Title 48 RCW, and is issued or renewed beginning January 1, 2012, and provides coverage for cancer chemotherapy treatment must provide coverage for prescribed, self administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis at least comparable to cancer chemotherapy medications administered by a health care provider or facility as defined in RCW 48.43.005(15) and (16).

    (2) Nothing in this section may be interpreted to prohibit a health plan from administering a formulary or preferred drug list, requiring prior authorization, or imposing other appropriate utilization controls in approving coverage for any chemotherapy.

NEW SECTION.  Sec. 3. A new section is added to chapter 48.20 RCW to read as follows:

    (1) Each health plan issued or renewed on or after January 1, 2012, that provides coverage for cancer chemotherapy treatment must provide coverage for prescribed, self administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis at least comparable to cancer chemotherapy medications administered by a health care provider or facility as defined in RCW 48.43.005(15) and (16).

    (2) Nothing in this section may be interpreted to prohibit a health plan from administering a formulary or preferred drug list, requiring prior authorization, or imposing other appropriate utilization controls in approving coverage for any chemotherapy.

NEW SECTION.  Sec. 4. A new section is added to chapter 48.21 RCW to read as follows:

    (1) Each health plan issued or renewed on or after January 1, 2012, that provides coverage for cancer chemotherapy treatment must provide coverage for prescribed, self administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis at least comparable to cancer chemotherapy medications administered by a health care provider or facility as defined in RCW 48.43.005(15) and (16).

    (2) Nothing in this section may be interpreted to prohibit a health plan from administering a formulary or preferred drug list, requiring prior authorization, or imposing other appropriate utilization controls in approving coverage for any chemotherapy.

NEW SECTION.  Sec. 5. A new section is added to chapter 48.44 RCW to read as follows:

    (1) Each health plan issued or renewed on or after January 1, 2012, that provides coverage for cancer chemotherapy treatment must provide coverage for prescribed, self administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis at least comparable to cancer chemotherapy medications administered by a health care provider or facility as defined in RCW 48.43.005(15) and (16).

    (2) Nothing in this section may be interpreted to prohibit a health plan from administering a formulary or preferred drug list, requiring prior authorization, or imposing other appropriate utilization controls in approving coverage for any chemotherapy.

NEW SECTION.  Sec. 6. A new section is added to chapter 48.46 RCW to read as follows:

    (1) Each health plan issued or renewed on or after January 1, 2012, that provides coverage for cancer chemotherapy treatment must provide coverage for prescribed, self administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis at least comparable to cancer chemotherapy medications administered by a health care provider or facility as defined in RCW 48.43.005(15) and (16).

    (2) Nothing in this section may be interpreted to prohibit a health plan from administering a formulary or preferred drug list, requiring prior authorization, or imposing other appropriate utilization controls in approving coverage for any chemotherapy."

EFFECT:

· Changes the category of medications to which the bill applies from "orally administered" medications to "self administered" medications;

· Requires health plans to offer self administered drugs on a basis at least comparable to chemotherapy medications administered by health providers or facilities (the original bill required the medications to be offered on a comparable basis to chemotherapy medications administered intravenously or by injection); and

· Allows health plans to administer a formulary or preferred drug list. 

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