Health care coverage: cancer treatment.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. 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 contracts 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 would prohibit a health care service plan contract and a health insurance policy issued, amended, or renewed on or after July 1, 2013, that provides coverage for cancer chemotherapy treatment from requiring a higher copayment, deductible, or coinsurance amount for a prescribed, orally administered anticancer medication than the health care service plan or health insurer requires for an intravenously administered or injected cancer medication, as specified. The bill would prohibit a health care service plan or a health insurer from being deemed to have complied with these provisions by increasing the copayment, deductible, or coinsurance amount for an intravenously administered or injected cancer chemotherapy agent. The bill would specify that its provisions do not apply to a health care service plan contract or health insurance policy that does not provide outpatient prescription drug coverage or to a health care benefit plan, contract, or policy with the Board of Administration of the Public Employees' Retirement System. The bill would also provide 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. Because a willful violation of the bill's requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.