Section 1367.656 Of Article 5. Standards From California Health And Safety Code >> Division 2. >> Chapter 2.2. >> Article 5.
1367.656
. (a) Notwithstanding any other law, an individual or group
health care service plan contract issued, amended, or renewed on or
after January 1, 2015, that provides coverage for prescribed, orally
administered anticancer medications used to kill or slow the growth
of cancerous cells shall comply with all of the following:
(1) Notwithstanding any deductible, the total amount of copayments
and coinsurance an enrollee is required to pay shall not exceed two
hundred dollars ($200) for an individual prescription of up to a
30-day supply of a prescribed orally administered anticancer
medication covered by the contract.
(2) For a health care service plan contract that meets the
definition of a "high deductible health plan" set forth in Section
223(c)(2) of Title 26 of the United States Code, paragraph (1) shall
only apply once an enrollee's deductible has been satisfied for the
year.
(3) Paragraph (1) shall not apply to any coverage under a health
care service plan contract for the Medicare Program pursuant to Title
XVIII of the federal Social Security Act (42 U.S.C. Sec. 1395 et
seq.).
(4) On January 1, 2016, and on January 1 of each year thereafter,
health care service plans may adjust the two hundred dollar ($200)
limit described in paragraph (1). The adjustment shall not exceed the
percentage increase in the Consumer Price Index for that year.
(5) A prescription for an orally administered anticancer
medication shall be provided consistent with the appropriate standard
of care for that medication.
(b) This section shall remain in effect only until January 1,
2019, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2019, deletes or extends
that date.