NJ Insurance Law – The Governor Signs Bill Requiring Parity Of Health Insurance Coverage For Oral Anticancer Medications

By: Donna Russo, Esq.

On January 17, 2012, Governor Christie signed into law S1834 which requires that health insurers cover oral anticancer medications on a no less favorable basis than intravenous anticancer medications. This bill was first introduced in March, 2010.

S1834 will take effect 180 days after the enactment date and shall apply to all contracts and policies issued on or after the effective date. New Jersey has become one of a small number of states to pass this legislation. Similar bills are pending in various states.

S1834 is a very significant law allowing cancer patients to obtain expensive oral cancer drugs under their insurance policies. Previous to this bill, some insurance companies were not providing coverage for oral cancer drugs and would only cover intravenous and injected medications which would require the cancer patients to interrupt their lifestyles and submit themselves to a hospital or clinic to receive intravenous anticancer medication which may not be the suggested first line of treatment. It is common knowledge that new anticancer therapies are being developed in pill form and that not all these new drugs are available intravenously.

S1834 is that it applies to almost all policies whether large or small group, state or individual policies. The key aspects of this bill are:
(1) 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;
(2) An insurance 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 administer or injected or orally administered, that are covered under contract as of the effective date of this act.