Bill Text: NJ S1303 | 2010-2011 | Regular Session | Introduced
Bill Title: Requires insurers which provide prescription drug benefits to cover costs of medications for treating sickle cell anemia.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2010-02-08 - Introduced in the Senate, Referred to Senate Commerce Committee [S1303 Detail]
Download: New_Jersey-2010-S1303-Introduced.html
Sponsored by:
Senator NIA H. GILL
District 34 (Essex and Passaic)
SYNOPSIS
Requires insurers which provide prescription drug benefits to cover costs of medications for treating sickle cell anemia.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning insurance coverage for medications for the treatment of sickle cell anemia and supplementing Titles 17 and 26 of the Revised Statutes and Title 17B of the New Jersey Statutes.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. A hospital service corporation which provides hospital or medical expense benefits for expenses incurred in the purchase of prescription drugs under a contract, shall provide benefits under every such contract delivered, issued, executed or renewed in this State, 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, for any prescription drug expenses incurred in the treatment of sickle cell anemia which are determined to be medically necessary by the covered person's physician.
The benefits shall be provided to the same extent as for any other prescription drugs under the contract.
This section shall apply to those hospital service corporation contracts in which the hospital service corporation has reserved the right to change the premium.
2. A medical service corporation which provides hospital or medical expense benefits for expenses incurred in the purchase of prescription drugs under a contract, shall provide benefits under every such contract delivered, issued, executed or renewed in this State, 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, for any prescription drug expenses incurred in the treatment of sickle cell anemia which are determined to be medically necessary by the covered person's physician.
The benefits shall be provided to the same extent as for any other prescription drugs under the contract.
This section shall apply to those medical service corporation contracts in which the medical service corporation has reserved the right to change the premium.
3. A health service corporation which provides hospital or medical expense benefits for expenses incurred in the purchase of prescription drugs under a contract, shall provide benefits under every such contract delivered, issued, executed or renewed in this State, 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, for any prescription drug expenses incurred in the treatment of sickle cell anemia which are determined to be medically necessary by the covered person's physician.
The benefits shall be provided to the same extent as for any other prescription drugs under the contract.
This section shall apply to those health service corporation contracts in which the health service corporation has reserved the right to change the premium.
4. An individual health insurer which provides hospital or medical expense benefits for expenses incurred in the purchase of prescription drugs under a policy, shall provide benefits under every such policy delivered, issued, executed or renewed in this State, 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, for any prescription drug expenses incurred in the treatment of sickle cell anemia which are determined to be medically necessary by the covered person's physician.
The benefits shall be provided to the same extent as for any other prescription drugs under the policy.
This section shall apply to those insurance policies in which the insurer has reserved the right to change the premium.
5. A group health insurer which provides hospital or medical expense benefits for expenses incurred in the purchase of prescription drugs under a policy, shall provide benefits under every such policy delivered, issued, executed or renewed in this State, 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, for any prescription drug expenses incurred in the treatment of sickle cell anemia which are determined to be medically necessary by the covered person's physician.
The benefits shall be provided to the same extent as for any other prescription drugs under the policy.
This section shall apply to those insurance policies in which the insurer has reserved the right to change the premium.
6. A certificate of authority to establish and operate a health maintenance organization in this State shall not be issued or continued on or after the effective date of this act for a health maintenance organization which provides health care services for prescription drugs under an enrollee contract, unless the health maintenance organization provides health care services for any prescription drug for the treatment of sickle cell anemia which is determined to be medically necessary by the enrollee's physician.
The benefits shall be provided to the same extent as for any other prescription drugs under the contract.
The provisions of this section shall apply to those contracts for health care services by health maintenance organizations under which the right to change the schedule of charges for enrollee coverage is reserved.
7. An individual health benefits plan issued pursuant to P.L.1992, c.161 (C.17B:27A-2 et seq.), which provides benefits for prescription drugs, shall provide benefits under every such plan delivered, issued, executed or renewed in this State or approved for issuance or renewal in this State, on or after the effective date of this act, for any prescription drug expenses incurred in the treatment of sickle cell anemia which are determined to be medically necessary by the covered person's physician.
The benefits shall be provided to the same extent as for any other prescription drugs under the health benefits plan.
This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
8. A small employer health benefits plan issued pursuant to P.L.1992, c.162 (C.17B:27A-17 et seq.), which provides benefits for prescription drugs, shall provide benefits under every such plan delivered, issued, executed or renewed in this State or approved for issuance or renewal in this State, on or after the effective date of this act, for any prescription drug expenses incurred in the treatment of sickle cell anemia which are determined to be medically necessary by the covered person's physician.
The benefits shall be provided to the same extent as for any other prescription drugs under the health benefits plan.
This section shall apply to those health benefits plans in which the carrier has reserved the right to change the premium.
9. A prepaid prescription service organization which provides prescription drug benefits under a contract, shall provide benefits under every such contract delivered, issued, executed or renewed in this State, 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, for any prescription drug expenses incurred in the treatment of sickle cell anemia which are determined to be medically necessary by the covered person's physician.
The benefits shall be provided to the same extent as for any other prescription drugs under the contract.
This section shall apply to those prepaid prescription plans in which the prepaid prescription service organization has reserved the right to change the premium.
10. This act shall take effect on the 90th day after enactment and shall apply to all contracts and policies issued or renewed on or after the effective date.
STATEMENT
This bill requires hospital, medical and health service corporations, individual, small employer and large group insurers, health maintenance organizations, and prepaid prescription service organizations which provide prescription drug benefits to cover any prescription drug expenses incurred in the treatment of sickle cell anemia which are determined to be medically necessary by the insured person's physician.
New drug therapies have emerged from clinical studies in recent years as promising methods of treatment for sickle cell anemia. These include hydroxyurea, a chemotherapeutic agent which achieved significant beneficial results when administered daily to persons with this inherited blood disorder, according to the National Heart, Lung and Blood Institute. Although no cure has yet been found for sickle cell anemia, there are currently a number of therapies that reduce the severity and frequency of the pain episodes and limit the organ damage that result from the disease. These therapies have produced great improvements in the quality and length of life for persons with sickle cell anemia in the past decade.
