1Requiring health insurance policies to provide coverage for
2tobacco cessation programs and drugs.

3The General Assembly of the Commonwealth of Pennsylvania
4hereby enacts as follows:

5Section 1. Short title.

6This act shall be known and may be cited as the Tobacco
7Cessation Treatment Act.

8Section 2. Findings.

9The General Assembly finds and declares as follows:

10(1) Providing tobacco cessation counseling and
11medication is one of the most clinically effective and cost-
12effective health services available, according to the
13National Commission on Prevention Priorities. Tobacco
14cessation is 5 to 80 times more cost effective than
15pharmacologic interventions used to prevent heart attacks.

16(2) More than 70% of smokers wish they could quit
17tobacco and each year one of every two smokers attempts to
18quit. However, the unassisted successful tobacco quit rate

1has remained constant at less than 5%. Access to counseling
2and pharmaceutical benefits doubles the successful quit rate
3and has achieved quit rates of 25% to 30%. Experience in
4health plans indicates that access to all cessation services
5saves $4 for every dollar invested.

6(3) Each adult smoker costs employers $1,760 in lost
7productivity and $1,623 in excess medical expenditures. Men
8who smoke incur $15,800 more in lifetime medical expenses
9than do men who do not smoke. For employers, the ultimate
10financial return is between $5 and $6 for every dollar spent
11on tobacco cessation.

12(4) Because of member transfers between plans, financial
13savings and tobacco-related disease reductions are effective
14only if universally available to the entire insured
15population. Therefore, a mandate on all plans and insurers to
16provide cost-effective treatment is necessary and beneficial.

17(5) It is the intent of the General Assembly that this
18act diminish the Statewide economic and personal cost of
19tobacco addiction by making tobacco cessation treatments
20available to all smokers. Approximately 20,000 Pennsylvania
21adults die annually, at a rate of 16%, from smoking-related
22causes. Tobacco-related personal health care costs total
23approximately $4.7 billion annually in Pennsylvania.

24Section 3. Definitions.

25The following words and phrases when used in this act shall
26have the meanings given to them in this section unless the
27context clearly indicates otherwise:

28"Course of treatment." One of the following:

29(1) In the case of counseling, treatment consisting of
30at least four sessions of counseling lasting at least ten

1minutes.

2(2) In the case of a prescription or over-the-counter
3medication, the duration of treatment approved by the Food
4and Drug Administration for that medication.

5"Health insurance policy."

6(1) An individual or group health insurance policy that
7is delivered, issued for delivery, renewed, extended or
8modified in this Commonwealth.

9(2) The term does not include any of the following types
10of insurance or a combination of any of the following types
11of insurance:

12(i) Short-term travel.

13(ii) Accident-only.

14(iii) Workers' compensation.

15(iv) Short-term nonrenewable policies of not more
16than six months' duration.

17(v) Hospital indemnity.

18(vi) Specified disease.

19(vii) Disability income.

20(viii) Dental.

21(ix) Vision.

22(x) Civilian Health and Medical Program of the
23Uniformed Services (CHAMPUS) supplement.

24(xi) Medicare or Medicaid supplemental contract.

25(xii) Long-term care.

26Section 4. Mandated coverage.

27(a) General rule.--Every health insurance policy that is
28delivered, issued for delivery, renewed, extended or modified in
29this Commonwealth on or after the effective date of this section
30shall provide for tobacco cessation services that follow

1recommendations in the Public Health Service-sponsored 2008
2clinical practice guideline, "Treating Tobacco Use and
3Dependence: 2008 Update," or its successors. The coverage shall
4include at least two courses of treatment in a 12-month period
5including personal counseling, which may be telephone, group or
6individual counseling, and all medications approved by the Food
7and Drug Administration for the purpose of tobacco cessation,
8including all prescription and over-the-counter medications.

9(b) Copayment, coinsurance or deductible.--No copayment,
10coinsurance or deductible may be applied to benefits under this
11section.

12(c) Contracting.--A health insurer may contract with
13qualified local, Statewide or national providers, whether for
14profit or nonprofit, for the provision of services under this
15section.

16(d) Disclosure.--An insurer shall disclose the benefits
17under this section in its evidence of coverage and disclosure
18forms and communicate the availability of coverage to all
19insureds at least once per year.

20(e) Counseling.--No patient may be required to enter
21counseling in order to receive medications for tobacco cessation
22treatment.

23(f) Prior authorization.--No health care plan may impose
24prior authorization or stepped care requirements on tobacco
25cessation treatment.

26Section 5. Effective date.

27This act shall take effect in 60 days.