Washington State

House of Representatives

Office of Program Research

BILL

ANALYSIS

Health Care & Wellness Committee

HB 1517

This analysis was prepared by non-partisan legislative staff for the use of legislative members in their deliberations. This analysis is not a part of the legislation nor does it constitute a statement of legislative intent.

Brief Description: Requiring comparable coverage for patients who require orally administered anticancer medication.

Sponsors: Representatives Jinkins, Hinkle, Green, Harris and Stanford.

Brief Summary of Bill

  • Requires health plans that cover chemotherapy to provide coverage for oral chemotherapy drugs on a basis comparable to intravenously administered or injected chemotherapy drugs.

Hearing Date: 2/2/11

Staff: Jim Morishima (786-7191).

Background:

Oral Chemotherapy Medications.

Chemotherapy is a type of cancer treatment involving drugs that target rapidly-dividing cells. Most chemotherapy is delivered via parenteral routes. However, some chemotherapy drugs, such as Melphalan and Busulfan, can be delivered orally. Some oral chemotherapy drugs are capable of targeting cancerous cells, leaving healthy cells unharmed. Others are biologic agents or hormones. Some oral chemotherapy medications are the standard of care for certain cancer types and do not have parenterel alternatives.

Mandated Benefit Sunrise Review.

In December 2010, the Department of Health (DOH) completed a sunrise review of mandated coverage for oral chemotherapy drugs. The DOH concluded that the proposal "is in the best interest of the public and the benefits outweigh the costs of parity legislation for oral anti-cancer treatments." However, the DOH also concluded that there may be some unintended consequences associated with the proposal, such as less favorable coverage for parenteral chemotherapy drugs and lack of coverage for biologic agents.

Summary of Bill:

Beginning January 1, 2012, health plans (including health plans offered to public employees and their dependents) that provide coverage for chemotherapy must provide coverage for prescribed, orally administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis comparable to intravenously administered or injected cancer medications. This does not prohibit a health plan from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for any chemotherapy.

Appropriation: None.

Fiscal Note: Requested on January 26, 2011.

Effective Date: The bill takes effect 90 days after adjournment of the session in which the bill is passed.