Oklahoma § 36-6060.9 - Coverage for wigs or other scalp prostheses

§ 36-6060.9. Coverage for wigs or other scalp prostheses

A. Any health benefit plan, including the State and Education

Employees Group Health Insurance Plan, that is offered, issued, or

renewed in this state on or after January 1, 2001, that provides

medical and surgical benefits with respect to the treatment of

cancer and other conditions treated by chemotherapy or radiation

therapy shall provide coverage for wigs or other scalp prostheses

necessary for the comfort and dignity of the covered person.

B. The coverage provided for by this section shall be subject

to the same annual deductibles, copayments, or coinsurance limits as

established for all other covered benefits under the health benefit

plan not to exceed One Hundred Fifty Dollars ($150.00) annually.

C. A health benefit plan shall provide notice to each insured

or enrollee under the plan regarding the coverage required by this

section in the evidence of coverage of the plan and shall provide

additional written notice of the coverage to the insured or enrollee

as follows:

1. In the next mailing made by the plan to the insured or

enrolled employee;

2. As part of any yearly informational packet sent to the

enrollee; or

3. Not later than December 1, 2000;

whichever is earlier.

D. As used in this act, "health benefit plan" means any plan or

arrangement as defined in subsection C of Section 6060.4 of this

title. However, this section shall not apply to policies or

Oklahoma Statutes - Title 36. Insurance

certificates issued to individuals or groups with fifty (50) or

fewer employees or plans offered under the State Medicaid Program.

E. The Insurance Commissioner shall promulgate any rules

necessary to implement the provisions of this section.

Added by Laws 2000, c. 171, § 4, eff. July 1, 2000. Amended by Laws

2010, c. 222, § 40, eff. Nov. 1, 2010.

§36-6060.9a. Anti-cancer medication coverage.

A. 1. Any health benefit plan that provides coverage and

benefits for cancer treatment shall provide coverage of prescribed

orally administered anticancer medications on a basis no less

favorable than intravenously administered or injected cancer

medications.

2. Coverage of orally administered anticancer medication shall

not be subject to any prior authorization, dollar limit, copayment,

deductible, or other out-of-pocket expense that does not apply to

intravenously administered or injected cancer medication, regardless

of formulation or benefit category determination by the company

administering the health benefit plan.

3. A health benefit plan shall not reclassify or increase any

type of cost-sharing to the covered person for anticancer

medications in order to achieve compliance with this section. Any

change in health insurance coverage that otherwise increases an outof-pocket expense to anticancer medications shall also be applied to

the majority of comparable medical or pharmaceutical benefits

covered by the health benefit plan.

4. A health benefit plan that limits the total amount paid by a

covered person through all cost-sharing requirements to no more than

One Hundred Dollars ($100.00) per filled prescription for any orally

administered anticancer medication shall be considered in compliance

with this section. For purposes of this paragraph, "cost-sharing

requirements" shall include copayments, coinsurance, deductibles,

and any other amounts paid by the covered person for that

prescription.

B. As used in this section:

1. "Anticancer medications" means medications used to kill or

slow the growth of cancer cells;

2. "Covered person" means a policyholder, subscriber, enrollee,

or other individual enrolled in or insured by a health benefit plan

for health insurance coverage; and

3. "Health benefit plan" means any plan or arrangement as

defined in subsection C of Section 6060.4 of Title 36 of the

Oklahoma Statutes.

Added by Laws 2013, c. 115, § 1, eff. Nov. 1, 2013.

§36-6060.9b. Cancer therapy coverage – Standard for proton

radiation therapy.

Oklahoma Statutes - Title 36. Insurance

A. A health benefit plan, as defined in subsection C of Section

6060.4 of Title 36 of the Oklahoma Statutes, that provides coverage

for cancer therapy shall be prohibited from holding proton radiation

therapy to a higher standard of clinical evidence for medical policy

benefit coverage decisions than the health plan requires for

coverage of any other radiation therapy treatment.

B. Nothing in this section shall be construed to mandate the

coverage of proton radiation therapy by a health benefit plan.

Added by Laws 2015, c. 74, § 1, eff. Nov. 1, 2015.

§36-6060.9c. Anti-abuse-formulated opioids - Study of effectiveness

The College of Pharmacy at Southwestern Oklahoma State

University shall analyze the effectiveness of the anti-abuse

properties of anti-abuse-formulated opioids. In addition, the

College of Pharmacy shall analyze the discrepancies between

insurance coverage for the anti-abuse-formulated prescription

opioids and coverage for prescription opioids without abusedeterrent properties. Such information shall be submitted in a

report to the President Pro Tempore of the Senate and the Speaker of

the House of Representatives on or before December 31, 2016.

Added by Laws 2016, c. 381, § 1, eff. Nov. 1, 2016.

§36-6060.9d. Prescription eyedrop refills.

A. Any health benefit plan issued or renewed on or after

November 1, 2017, that provides coverage for prescription eyedrops

shall not deny coverage for a refill of a prescription if:

1. For a thirty-day supply, the amount of time has passed after

which a patient should have used seventy percent (70%) of the dosage

units of the drug according to a practitioner's instructions, or

twenty-one (21) days from:

a.

the original date the prescription was distributed to

the insured, or

b.

the date the most recent refill was distributed to the

insured;

2. The prescribing practitioner indicates on the original

prescription that additional quantities are needed;

3. The refill requested by the insured does not exceed the

number of additional quantities needed; and

4. The prescription eyedrops prescribed by the practitioner are

a covered benefit under the policy or contract to the insured.

B. As used in this section, "health benefit plan" means any

plan or arrangement as defined in subsection C of Section 6060.4 of

Title 36 of the Oklahoma Statutes.

Added by Laws 2017, c. 15, § 1, eff. Nov. 1, 2017.