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2016 SESSION
16102574DBe it enacted by the General Assembly of Virginia:
1. That § 38.2-3407.18 of the Code of Virginia is amended and reenacted as follows:
§ 38.2-3407.18. Coverage for oral chemotherapy medications.
A. Each Notwithstanding the provisions of § 38.2-3419,
each (i) insurer proposing to issue individual
or group accident and sickness insurance policies providing
hospital, medical and surgical, or major medical coverage on an
expense-incurred basis; (ii) corporation providing individual or
group accident and sickness subscription contracts; and (iii) health maintenance
organization providing a health care plan for health care services, whose
policies, contracts, or plans, including any certificate or evidence of
coverage issued in connection with such policies, contracts, or plans, include
coverage for cancer chemotherapy drugs administered orally
and intravenously or by injection shall provide that the criteria for
establishing cost sharing applicable to orally administered cancer chemotherapy
drugs and cancer chemotherapy drugs that are administered intravenously or by
injection shall be consistently applied within the same plan treatment, (a) shall
provide coverage under such policy, contract, or plan for a prescribed, orally
administered anticancer medication on a basis no less favorable than that on
which it provides coverage for intravenously administered or injected
anticancer medications and (b) shall not
require a higher copayment, deductible, or coinsurance amount for a prescribed,
orally administered anticancer medication that is used to kill or slow the growth
of cancerous cells than what the policy, contract, or plan requires for an
intravenously administered or injected anticancer medication that is provided,
regardless of formulation or benefit category determination by the insurer,
corporation, or health maintenance organization.
B. The
requirements of this section shall apply to all insurance policies, contracts,
and plans delivered, issued for delivery, reissued, renewed, or extended or at
any time when any term of any such policy, contract, or plan is changed or any
premium adjustment is made, on and after the effective date of this section. An insurer, corporation, or health maintenance
organization shall not achieve compliance with this section by imposing an
increase in copayment, deductible, or coinsurance amount for an intravenously
administered or injected anticancer chemotherapy agent covered under the
policy, contract, or plan.
C. Nothing in this section shall be interpreted to (i) prohibit an insurer, corporation, or health maintenance organization from requiring prior authorization or imposing other appropriate utilization controls in approving coverage for any chemotherapy or (ii) require coverage in a policy, contract, or plan for cancer chemotherapy treatment.
D. The provisions of this section shall not apply to short-term travel, accident only, or limited or specified disease policies or contracts, nor to policies or contracts designed for issuance to persons eligible for coverage under Title XVIII of the Social Security Act, known as Medicare, or any other similar coverage under state or federal governmental plans.
C. E. This
section shall apply to health coverage offered to state employees pursuant to §
2.2-2818 and to health insurance coverage offered to employees of local
governments, local officers, teachers, and retirees, and the dependents of such
employees, local officers, teachers and retirees pursuant to § 2.2-1204. In administering such coverage, the criteria for
establishing the level of copayments or coinsurance for orally administered
cancer treatment drugs and cancer chemotherapy drugs that are administered
intravenously or by injection shall be consistently applied within the same
plan.
2. That the provisions of this act shall apply to insurance policies, contracts, and plans delivered, issued for delivery, reissued, or extended on and after July 1, 2016, or at any time thereafter when any term of the policy, contract, or plan is changed or any premium adjustment is made.