Delaware Code Title 18 Sec. 3555A – Equal reimbursement for oral and intravenous anticancer medication
(a) Every group or blanket policy or contract of health insurance, or certificate issued thereunder, which is delivered, issued for delivery, renewed, modified, altered, or amended in this State on or after January 1, 2013, and which provides medical, major medical, or similar comprehensive-type coverage, and provides coverage for prescription drugs, and which also provides coverage for anticancer medication, must provide coverage for a prescribed, orally administered anticancer medication used to kill or slow the growth of cancerous cells, and must apply the lower cost sharing of either:
(1) Anticancer medication under the prescription drug benefit, or
(2) Intravenous or injected anticancer medications.
Terms Used In Delaware Code Title 18 Sec. 3555A
- Contract: A legal written agreement that becomes binding when signed.
- State: means the State of Delaware; and when applied to different parts of the United States, it includes the District of Columbia and the several territories and possessions of the United States. See Delaware Code Title 1 Sec. 302
For purposes of this section, the term “cost sharing” may include co-pays, coinsurance, and deductibles, as considered appropriate by the Commissioner.
(b) An insurer who provides coverage under this section and any participating entity through which the insurer offers health services may not:
(1) Vary the terms of the policy for the purpose of or with the effect of avoiding compliance with this section;
(2) Provide incentives, monetary or otherwise, to encourage a covered person to accept less than the minimum protections available under this section;
(3) Penalize in any way or reduce or limit the compensation of a healthcare practitioner for recommending or providing care to a covered person in accordance with this section;
(4) Provide incentives, monetary or otherwise, to a healthcare practitioner relating to the services provided pursuant to this section, intended to induce or have the effect of inducing the practitioner to provide care to a covered person in a manner inconsistent with this section; or
(5) Achieve compliance with this section by imposing an increase in cost sharing for an oral, intravenous, or injected anticancer medication covered under the policy on and following May 1, 2012.
(c) Nothing in this section may be interpreted to prohibit an insurer from requiring prior authorization for any anticancer treatment.
(d) Nothing in this section may be interpreted to require coverage for anticancer medication.