‘Resolve, Directing a Review of Strategies To Improve the Affordability and Accessibility of Oral Chemotherapy Treatment’

‘Sec. 1. Review and report. Resolved: That the Department of Professional and Financial Regulation, Bureau of Insurance and the Department of Health and Human Services, Maine Center for Disease Control and Prevention, referred to in this section as "the conveners," shall jointly convene a work group of stakeholders to review and report on insurance coverage as it relates to the affordability and accessibility of chemotherapy treatment in the State, including coverage disparities between orally administered, intravenously administered and injected chemotherapy. The conveners shall invite stakeholders to participate in the work group, including, but not limited to, oncologists, cancer patients and a hospital cancer center; representatives of the Maine Medical Association, American Cancer Society Cancer Action Network, Susan G. Komen Maine and Maine Cancer Consortium; 2 representatives of health insurance carriers; and the Joint Standing Committee on Insurance and Financial Services. The work group shall convene no later than October 1, 2013. The conveners shall facilitate the duties of the work group required by this resolve within existing resources and may rely on the expertise and resources of work group members to fulfill the duties described in this resolve; and be it further

Sec. 2. Duties. Resolved: That the duties of the work group under section 1 include, but are not limited to, the following:

1. Reviewing the federal laws and regulations pertaining to health insurance coverage for chemotherapy administered orally, intravenously and by injection, including the federal Patient Protection and Affordable Care Act, Public Law 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and the regulations pertaining to essential health benefits under that Act;

2. Reviewing studies from this State and other states regarding the affordability and accessibility of oral chemotherapy, as well as cost and actuarial analyses of coverage parity for oral chemotherapy;

3. Reviewing any available state data on insurance coverage for chemotherapy treatment administered orally, intravenously and by injection, including patient out-of-pocket costs and drug formularies;

4. Identifying the advantages and disadvantages of requiring coverage for prescribed, orally administered oral chemotherapy that is equivalent to the coverage provided for intravenously administered or injected oral chemotherapy; and

5. Making recommendations regarding requiring coverage for prescribed, orally administered oral chemotherapy; and be it further

Sec. 3. Report. Resolved: That, by December 1, 2013, the Department of Professional and Financial Regulation, Bureau of Insurance, after consultation with the Department of Health and Human Services, Maine Center for Disease Control and Prevention and work group members, shall submit a written report on behalf of the work group with the findings and any recommendations resulting from the review under section 1 to the Joint Standing Committee on Insurance and Financial Services. The joint standing committee may report out a bill during the Second Regular Session of the 126th Legislature relating to the report; and be it further

Sec. 4. Appropriations and allocations. Resolved: That the following appropriations and allocations are made.

PROFESSIONAL AND FINANCIAL REGULATION, DEPARTMENT OF

Insurance - Bureau of 0092

Initiative: Allocates funds for the costs of contractual services to convene the work group and review and report on findings.

OTHER SPECIAL REVENUE FUNDS	2013-14	2014-15
All Other	$10,000	$0
OTHER SPECIAL REVENUE FUNDS TOTAL	$10,000	$0

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