Health Benefit Policy to Provide Coverage for Orally Administered Chemotherapy for the Treatment of Cancer; Definitions

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  5. General Provisions
  6. Health Benefit Policy to Provide Coverage for Orally Administered Chemotherapy for the Treatment of Cancer; Definitions

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  1. As used in this Code section, the term:
    1. "Cost sharing requirements" includes co-payments, coinsurance, deductibles, and any other amounts paid by the covered person for a prescription dispensed by a licensed retail pharmacy.
    2. "Health benefit policy" means any individual or group plan, policy, or contract for health care services issued, delivered, issued for delivery, executed, or renewed by an insurer in this state.The term "health benefit policy" does not include the following limited benefit insurance policies: accident only, CHAMPUS supplement, dental, disability income, fixed indemnity, long-term care, Medicaid, medicare supplement, specified disease, vision, self-insured plans, and nonrenewable individual policies written for a period of less than six months.
    3. "Insurer" means any person, corporation, or other entity authorized to provide health benefit policies under this title.
  2. A health benefit policy that provides coverage for intravenously administered or injected chemotherapy for the treatment of cancer shall provide coverage for orally administered chemotherapy for the treatment of cancer on a basis no less favorable than the intravenously administered or injected chemotherapy regardless of the formulation or benefit category determination by the insurer.
  3. An insurer providing a health benefit policy and any participating entity through which the insurer offers health services shall not:
    1. Vary the terms of any health benefit policy, to avoid compliance with this Code section;
    2. Provide any incentive, including, but not limited to, a monetary incentive, or impose treatment limitations to encourage a covered person to accept less than the minimum protections available under this Code section;
    3. Penalize a health care practitioner or reduce or limit the compensation of a health care practitioner for recommending or providing services or care to a covered person as required under this Code section;
    4. Provide any incentive, including, but not limited to, a monetary incentive, to induce a health care practitioner to provide care or services that do not comply with this Code section; or
    5. Change the classification of any intravenously administered or injected chemotherapy treatment or increase the amount of cost sharing applicable to any intravenously administered or injected chemotherapy, in order to achieve compliance with this Code section.
  4. An insurer that limits the total amount paid by a covered person through all cost sharing requirements to no more than $200.00 per filled prescription for any orally administered chemotherapy shall be deemed to be in compliance with this Code section.

(Code 1981, §33-24-56.5, enacted by Ga. L. 2014, p. 243, § 2-2/HB 943; Ga. L. 2019, p. 386, § 57/SB 133.)

The 2019 amendment, effective July 1, 2019, deleted "on or after January 1, 2015" following "state" at the end of the first sentence of paragraph (a)(2); deleted "in effect on December 30, 2014" following "health benefit policy" in paragraph (c)(1); and deleted "in effect on January 1, 2015," following "chemotherapy" in paragraph (c)(5).

Editor's notes.

- Ga. L. 2014, p. 243, § 2-2/HB 943, not codified by the General Assembly, provides: "This Act shall be known and may be cited as the 'Cancer Treatment Fairness Act.'"

Law reviews.

- For article on the 2014 enactment of this Code section, see 31 Ga. St. U. L. Rev. 113 (2014).


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