CA AB 1000 - Health Care Coverage: Cancer Treatment

Existing law requires health care service plan contracts and health insurance policies to provide coverage for all generally medically accepted cancer screening tests and requires those plans and policies to also provide coverage for the treatment of breast cancer. Existing law imposes various requirements on contracts and policies that cover prescription drug benefits.

This bill, until January 1, 2016, would require health care service plan contracts and health insurance policies that provide coverage for cancer chemotherapy treatment to provide coverage for a prescribed, orally administered, nongeneric cancer medication, as specified. The bill would require a health care service plan or health insurer to review the percentage cost share for oral nongeneric cancer medications and intravenous or injected nongeneric cancer medications and to apply the lower of the 2 as the cost-sharing provision for oral nongeneric cancer medications. The bill would limit increases in cost sharing for nongeneric cancer medications. With a recent amendment, the bill would provide, however, that no benefits are required to be provided under its provisions that exceed the essential health benefits that will be required under specified federal law. The bill would also specify that its provisions do not apply to health care service plan contracts or health insurance policies that do not provide coverage for drugs. The bill would specify that its provisions do not apply to a health care benefit plan, contract, or health insurance policy with the Board of Administration of the Public Employees' Retirement System. AB 1000 passed the Assembly.

Filed under: Mandated Benefits
4th Quarter 2011

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