BILL REQ. #:  H-0712.4 

Read first time 01/25/11.   Referred to Committee on Health Care & Wellness.

     AN ACT Relating to requiring comparable coverage for patients who require orally administered anticancer medication; adding a new section to chapter 41.05 RCW; adding a new section to chapter 48.20 RCW; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; adding a new section to chapter 48.46 RCW; and creating a new section.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

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 an 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 oral 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 orally administered anticancer medication, the cost-sharing responsibilities for these patients must be equitable 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 that is not 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, 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.
     (2) Nothing in this section may be interpreted to prohibit a health plan from 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 beginning January 1, 2012, that provides coverage for cancer chemotherapy treatment 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.
     (2) Nothing in this section may be interpreted to prohibit a health plan from 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 beginning January 1, 2012, that provides coverage for cancer chemotherapy treatment 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.
     (2) Nothing in this section may be interpreted to prohibit a health plan from 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 beginning January 1, 2012, that provides coverage for cancer chemotherapy treatment 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.
     (2) Nothing in this section may be interpreted to prohibit a health plan from 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 beginning January 1, 2012, that provides coverage for cancer chemotherapy treatment 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.
     (2) Nothing in this section may be interpreted to prohibit a health plan from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for any chemotherapy.