A. An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state and that provides coverage for cancer treatment shall provide coverage for a prescribed, orally administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits by the plan.
B. An insurer shall not increase patient cost-sharing for anticancer medications in order to achieve compliance with the provisions of this section.
C. Coverage of orally administered anticancer medication shall not be subject to any prior authorization, dollar limit, copayment, deductible or coinsurance provision that does not apply to intravenously administered or injected anticancer medication used to kill or slow the growth of cancerous cells.
D. As used in this section, "insurer" or "health plan":
(1) means:
(a) a health insurer;
(b) a nonprofit health service provider;
(c) a health maintenance organization;
(d) a managed care organization; or
(e) a provider service organization; and
(2) does not include individual policies intended to supplement major medical group-type coverages such as medicare supplement, long-term care, disability income, specified disease, accident-only, hospital indemnity or other limited-benefit health insurance policies.
History: Laws 2011, ch. 55, § 2.
Effective dates. — Laws 2011, ch. 55, § 7 made Laws 2011, ch. 55, § 2 effective June 17, 2011.
Applicability. — Laws 2011, ch. 55, § 6 provided that the provisions of this act apply to insurance policies that provide coverage for cancer treatment and that are delivered, issued for delivery, amended, renewed or continued in this state on or after January 1, 2012.
Structure New Mexico Statutes
Article 22 - Health Insurance Contracts
Section 59A-22-1 - Scope of article.
Section 59A-22-2 - Form and content of policy.
Section 59A-22-3 - Required provisions.
Section 59A-22-4 - Entire contract; changes.
Section 59A-22-5 - Time limit on certain defenses.
Section 59A-22-6 - Grace period.
Section 59A-22-7 - Reinstatement.
Section 59A-22-8 - Notice of claim.
Section 59A-22-9 - Claim forms.
Section 59A-22-10 - Proofs of loss.
Section 59A-22-11 - Time of payment of claims.
Section 59A-22-12 - Payment of claims.
Section 59A-22-13 - Physical examination and autopsy.
Section 59A-22-14 - Legal actions.
Section 59A-22-15 - Change of beneficiary.
Section 59A-22-16 - Optional provisions.
Section 59A-22-17 - Change of occupation.
Section 59A-22-18 - Misstatement of age.
Section 59A-22-19 - Other insurance in this insurance company.
Section 59A-22-20 - Insurance with other insurance companies.
Section 59A-22-21 - Insurance with other insurance companies [; alternative provision].
Section 59A-22-22 - Relation of earnings to insurance.
Section 59A-22-23 - Unpaid premium.
Section 59A-22-24 - Cancellation.
Section 59A-22-25 - Conformity with state statutes.
Section 59A-22-26 - Order of certain policy provisions.
Section 59A-22-27 - Third party ownership.
Section 59A-22-28 - Requirements of other jurisdictions.
Section 59A-22-29 - Conforming to statute.
Section 59A-22-30 - Age limit.
Section 59A-22-30.1 - Maximum age of dependent.
Section 59A-22-31 - Industrial health insurance.
Section 59A-22-32 - Freedom of choice of hospital and practitioner.
Section 59A-22-32.1 - Freedom of choice.
Section 59A-22-33 - Children with disabilities; coverage continued.
Section 59A-22-34 - Newly born children coverage.
Section 59A-22-34.1 - Coverage for adopted children.
Section 59A-22-34.2 - Coverage of children.
Section 59A-22-34.3 - Childhood immunization coverage required.
Section 59A-22-34.4 - Coverage of circumcision for newborn males.
Section 59A-22-34.5 - Hearing aid coverage for children required.
Section 59A-22-35 - Maternity transport required.
Section 59A-22-36 - Home health care service option required.
Section 59A-22-39 - Coverage for mammograms.
Section 59A-22-39.2 - Prior authorization for gynecological or obstetrical ultrasounds prohibited.
Section 59A-22-40 - Coverage for cytologic and human papillomavirus screening.
Section 59A-22-40.1 - Coverage for the human papillomavirus vaccine.
Section 59A-22-41 - Coverage for individuals with diabetes.
Section 59A-22-41.1 - Coverage for medical diets for genetic inborn errors of metabolism.
Section 59A-22-42 - Coverage for prescription contraceptive drugs or devices.
Section 59A-22-43 - Required coverage of patient costs incurred in cancer clinical trials.
Section 59A-22-44 - Coverage for smoking cessation treatment.
Section 59A-22-45 - Coverage of alpha-fetoprotein IV screening test.
Section 59A-22-46 - Coverage of part-time employees.
Section 59A-22-47 - Coverage of colorectal cancer screening.
Section 59A-22-48 - General anesthesia and hospitalization for dental surgery.
Section 59A-22-49 - Coverage for autism spectrum disorder diagnosis and treatment.
Section 59A-22-49.2 - Coverage of prescription eye drop refills.
Section 59A-22-49.3 - Coverage for telemedicine services.
Section 59A-22-49.4 - Prescription drugs; prohibited formulary changes; notice requirements.
Section 59A-22-50 - Health insurers; direct services.
Section 59A-22-51 - Dental insurance plan; dental fees not covered; severability.
Section 59A-22-52 - Prescription drug prior authorization protocols.
Section 59A-22-53 - Pharmacy benefits; prescription synchronization.
Section 59A-22-53.2 - Pharmacist prescriptive authority services; reimbursement parity.
Section 59A-22-54 - Provider credentialing; requirements; deadline.
Section 59A-22-55 - Coverage exclusion. (Contingent repeal. See note.)
Section 59A-22-56 - Physical rehabilitation services; limits on cost sharing.