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.