Capital BlueCross Oral Chemotherapy Medications Mandate

Capital BlueCross announced that a new Pennsylvania law was enacted that requires parity between oral chemotherapy medications and intravenously administered or injected chemotherapy medications.  This new state mandate prohibits health insurance policies from providing coverage or imposing cost sharing for a prescribed, orally administered chemotherapy medication on a less favorable basis than the coverage the policy provides or cost sharing it imposes for intravenously administered or injected cancer chemotherapy medications.

Coverage Details

For mid-market and large group policies, the mandate applies to policies that will issue or be renewed beginning on or after February 1, 2017.  For small group and individual products, the new mandate will apply to all new and renewing policies beginning January 1, 2018.

Fully insured employer groups who have Rx benefit coverage with Capital BlueCross are required to comply with the state mandate. In order to meet the mandate’s parity requirements, Capital BlueCross has determined that coverage for oral chemotherapy medications under the Capital BlueCross Rx benefits plan will be provided at $0 member cost share. To ensure consistency with our mid-market and large group standard fully-insured business, Capital will also be applying the state mandate to the Small Business ASO and ASO Signature products.

“Customized” Administrative Services Only (ASO) groups are not required to adopt the state mandate. However, our ASO customers who have Rx benefit coverage with Capital BlueCross may choose to ‘opt in’ to cover this benefit for their employees.

Communications

Capital BlueCross groups and members will receive communication through our bi-annual publications. Employers and members will see information about this mandate in the spring editions of our publications, 360° For Business (formerly BenefitFocus) and SimplyWell.

DISCLOSURE

The information provided herein is intended solely for the use of our clients. You may not display, reproduce, copy, modify, license, sell or disseminate in any manner any information included herein, without the express permission of the Publisher or Publishers of articles within.

The information provided is for informational purposes only and does not constitute legal advice. The information above contains only a summary of the applicable legal provisions and does not purport to cover every aspect of any particular law, regulation or requirement. Depending on the specific facts of any situation, there may be additional or different requirements. This is to be used only as a guide and not as a definitive description of your compliance obligations.