West Virginia Code § 33-24-7m

Deductibles, copayments and coinsurance for anti-cancer medications
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(a) Notwithstanding any provision of any policy, provision, contract, plan or agreement to
which this article applies, any group accident and sickness insurance policy, plan, contract
or agreement issued by an entity regulated by this article that covers anti-cancer
medications that are injected or intravenously administered by a health care provider and
patient administered anti-cancer medications, including, but not limited to, ethose
medications orally administered or self-injected, may not require a less favorable basis for a
copayment, deductible or coinsurance amount for patient administeredr anti-cancer
medications than it requires for injected or intravenously administered anti-cancer
medications, regardless of the formulation or benefit category determination by the policy or
plan.
(b) An accident or sickness insurance policy, plan, contract or agreement may not comply
with subsection (a) of this section by:
(1) Increasing the copayment, deductible or coinsulrance amount required for injected or
intravenously administered anti-cancer medicsations that are covered under the policy or
plan; or
(2) Reclassifying benefits with respegct to anti-cancer medications.
(c) As used in this section, "anti-cancer medication" means a FDA approved medication
prescribed by a treating physician who determines that the medication is medically
necessary to kill or slow the growth of cancerous cells in a manner consistent with nationally
accepted standards of practice.
(d) This section is eff ective for policy and plan years beginning on or after January 1, 2016.
This section aVpplies to all group accident and sickness insurance policies and plans subject
to this article that are delivered, executed, issued, amended, adjusted or renewed in this
state, on and after the effective date of this section.
(e) Notwithstanding any other provision in this section to the contrary, in the event that an
entity subject to this article can demonstrate actuarially to the Insurance Commissioner that
its total anticipated costs for any policy, plan, contract or agreement to comply with this
section will exceed or have exceeded two percent of the total costs for such policy, plan,
contract or agreement in any experience period, then the entity may apply whatever cost
containment measures may be necessary to maintain costs below two percent of the total
costs for the policy, plan, contract or agreement: Provided, That such cost containment
measures implemented are applicable only for the plan year or experience period following
approval of the request to implement cost containment measures.
(f) For any enrollee that is enrolled in a catastrophic plan as defined in Section 1302(e) of
the Affordable Care Act or in a plan that, but for this requirement, would be a High
Deductible Health Plan as defined in section 223(c)(2)(A) of the Internal Revenue Code of
1986, and that, in connection with every enrollment, opens and maintains for each enrollee a
Health Savings Account as that term is defined in section 223(d) of the Internal Revenue
Code of 1986, the cost-sharing limit outlined in subsection (a) of this section shall be
applicable only after the minimum annual deductible specified in section 223(c)(2)(A) of the
Internal Revenue Code of 1986 is reached. In all other cases, this limit shall be applicable at
any point in the benefit design, including before and after any applicable deductible is
reached. e

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