§ 415-6-t

415:6-t Oral Anti-Cancer Therapies. – I. No insurer that issues or renews any individual policy, plan, or contract of accident or health insurance providing benefits for anti-cancer medications that are injected or intravenously administered by a health care provider and patient administered anti-cancer medications, including but not limited to those orally administered or self-injected, shall require a higher copayment, deductible, or coinsurance amount for patient administered anti-cancer medication than it requires for injected or intravenously administered anti-cancer medications, regardless of the formulation or benefit category determination by the policy or plan. II. An insurer shall not comply with paragraph I by: (a) Increasing the copayment, deductible, or coinsurance amount required for injected or intravenously administered anti-cancer medication that are covered under the policy or plan. (b) Reclassifying benefits with respect to anti-cancer medications. III. In this section, 'anti-cancer medication' means drugs and biologics that are used to kill, slow, or prevent the growth of cancerous cells. IV.

g benefits with respect to anti-cancer medications. III. In this section, 'anti-cancer medication' means drugs and biologics that are used to kill, slow, or prevent the growth of cancerous cells. IV. If the cost-sharing requirements for orally administered anti-cancer medications do not exceed $200 per prescription fill, the health plan shall be deemed in compliance with this section. V. For a health care contract that meets the definition of a 'high deductible plan' set forth in 26 U.S.C. section 223(c) (2), a carrier shall be exempt from the provisions of paragraphs I-IV until an enrollee's deductible has been satisfied for the year. VI. This section shall apply only to oral anti-cancer medications where an intravenously administered or injected anti-cancer medication is not medically appropriate. VII. This section shall not apply to policies which are solely to replace income or pay a predetermined fixed amount based on the occurrence of a specified medical or health event. Source. 2015, 263:6, eff. Jan. 1, 2017.