26:2J-4.35 HMO to provide coverage for oral anticancer medications.
8. a. A health maintenance organization contract for health care services that is delivered, issued, executed, or renewed in this State pursuant to P.L.1973, c.337 (C.26:2J-1 et seq.), or approved for issuance or renewal in this State by the Commissioner of Banking and Insurance, on or after the effective date of this act, shall provide health care services for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells on a basis no less favorable than the contract provides for covered intravenously administered or injected anticancer medications.
b.Pursuant to subsection a. of this section, coverage for expenses for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medications.
c.A health maintenance organization contract shall not achieve compliance with the provisions of this section by imposing an increase in patient cost sharing, including any copayment, deductible or coinsurance, for anticancer medications, whether intravenously administered or injected or orally administered, that are covered under the contract as of the effective date of this act.
d.This section shall apply to those contracts for health care services under which the right to change the schedule of charges for enrollee coverage is reserved.
L.2011, c.188, s.8.
Section: Previous 26-2j-4.28 26-2j-4.29 26-2j-4.30 26-2j-4.31 26-2j-4.32 26-2j-4.33 26-2j-4.34 26-2j-4.35 26-2j-4.36 26-2j-4.37 26-2j-4.38 26-2j-5 26-2j-6 26-2j-7 26-2j-8 Next
Last modified: October 11, 2016