Regular Session 2015-2016 House Bill 0060 P.N. 3646

SENATE AMENDED

PRIOR PRINTER'S NOS. 52, 1921

PRINTER'S NO. 3646

THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

No.

Session of

2015

INTRODUCED BY BAKER, BENNINGHOFF, COHEN, TOEPEL, V. BROWN,

FREEMAN, BARRAR, BROWNLEE, LONGIETTI, KILLION, SAMUELSON,

DiGIROLAMO, TOPPER, RAPP, CAUSER, A. HARRIS, KNOWLES,

KAUFFMAN, OBERLANDER, D. COSTA, MILLARD, WATSON, CUTLER,

EVERETT, MURT, JAMES, DeLUCA, HAHN, GABLER, GINGRICH,

ZIMMERMAN, PICKETT, GIBBONS, DEAN, MENTZER, EMRICK, BIZZARRO,

PHILLIPS-HILL, MOUL, PYLE, REGAN AND McCARTER,

JANUARY 21, 2015

AS AMENDED ON THIRD CONSIDERATION, IN SENATE, JUNE 27, 2016

AN ACT

Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An

act relating to insurance; amending, revising, and

consolidating the law providing for the incorporation of

insurance companies, and the regulation, supervision, and

protection of home and foreign insurance companies, Lloyds

associations, reciprocal and inter-insurance exchanges, and

fire insurance rating bureaus, and the regulation and

supervision of insurance carried by such companies,

associations, and exchanges, including insurance carried by

the State Workmen's Insurance Fund; providing penalties; and

repealing existing laws," in casualty insurance, providing

for coverage for oral anticancer CHEMOTHERAPY medications.

The General Assembly of the Commonwealth of Pennsylvania

hereby enacts as follows:

Section 1. The act of May 17, 1921 (P.L.682, No.284), known

as The Insurance Company Law of 1921, is amended by adding a

section to read:

Section 631.1. Coverage for Oral Anticancer CHEMOTHERAPY

Medications.--(a) Whenever a health insurance policy provides

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coverage that includes coverage for cancer chemotherapy or

anticancer INTRAVENOUSLY ADMINISTERED OR INJECTED CHEMOTHERAPY

medications which have been approved by the United States Food

and Drug Administration for general use in the treatment of

cancer, the policy shall not provide coverage or impose cost

sharing for a prescribed, orally administered anticancer

CHEMOTHERAPY medication on a less favorable basis than the

coverage it provides or cost sharing it imposes for

intravenously administered or injected cancer CHEMOTHERAPY

medications.

(b) A health insurance policy shall not comply with this

section by imposing an increase in cost sharing solely for

orally administered, intravenously administered or injected

cancer medications. CHEMOTHERAPY MEDICATIONS GREATER THAN THE

POLICY'S COST-SHARING PROVISIONS FOR MEDICAL BENEFITS GENERALLY.

INCREASE COST SHARING FOR CHEMOTHERAPY MEDICATIONS IN ORDER TO

AVOID COMPLIANCE WITH SUBSECTION (A). A HEALTH INSURANCE POLICY

MAY INCREASE COST SHARING FOR CHEMOTHERAPY MEDICATIONS IF AN

INCREASE IS APPLIED GENERALLY TO OTHER MEDICAL OR PHARMACEUTICAL

BENEFITS ADMINISTERED IN A SIMILAR HEALTH CARE SETTING UNDER THE

CONTRACT.

preclude a health insurance policy from requiring an enrollee to

obtain prior authorization before orally administered anticancer

CHEMOTHERAPY medication is dispensed to the enrollee. AS PART OF

PRIOR AUTHORIZATION, AN INSURER MAY CONSIDER THE MEDICAL

NECESSITY AND COST OF ORAL CHEMOTHERAPY MEDICATIONS COMPARED

WITH INTRAVENOUSLY ADMINISTERED OR INJECTED CHEMOTHERAPY

MEDICATION.

(D) THIS SECTION SHALL APPLY ONLY TO ORAL CHEMOTHERAPY

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MEDICATIONS WHERE AN INTRAVENOUSLY ADMINISTERED OR INJECTED

CHEMOTHERAPY MEDICATION IS NOT EQUALLY MEDICALLY EFFECTIVE.

(E) THIS SECTION SHALL APPLY TO A HIGH DEDUCTIBLE HEALTH

PLAN ONLY , AS DEFINED IN SECTION 223(C)(2) OF THE INTERNAL

REVENUE CODE OF 1986 (PUBLIC LAW 99-514, 26 U.S.C. § 223(C)(2)),

ONLY AFTER THE COVERED PERSON'S DEDUCTIBLE HAS BEEN SATISFIED

FOR THE YEAR.

(d) (F) (E) This section shall apply to those health

insurance policies issued or entered into or renewed on or after

the effective date of this section.

(e) (G) (F) As used in this section:

" Anticancer CHEMOTHERAPY medication" means a drug or

biological product that is used to kill, slow or prevent

MEDICATION PRESCRIBED BY A TREATING PHYSICIAN HEALTH CARE

PRACTITIONER THAT IS NECESSARY TO KILL OR SLOW the growth of

cancerous cells.

"Cost sharing" means the cost to an individual insured under

a health insurance policy according to any coverage limit,

copayment, coinsurance, deductible or other out-of-pocket

expense requirements imposed by the policy, contract or

agreement.

"Health insurance policy" means any individual or group

health, sickness or accident policy, or subscriber contract or

certificate offered, issued or renewed by an entity subject to

one of the following:

(1) This act.

(2) The act of December 29, 1972 (P.L.1701, No.364), known

as the "Health Maintenance Organization Act."

(3) 40 Pa.C.S. Ch. 61 (relating to hospital plan

corporations) or 63 (relating to professional health services

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plan corporations).

The term does not include accident only, fixed indemnity,

limited benefit, credit, dental, vision, specified disease,

Medicare supplement, Civilian Health and Medical Program of the

Uniformed Services (CHAMPUS) supplement, long-term care or

disability income, workers' compensation or automobile medical

payment insurance.

Section 2. The addition of section 631.1 of the act applies

as follows:

(1) For health insurance policies for which either rates

or forms are required to be filed with the Insurance

Department or the Federal Government, section 631.1 of the

act shall apply to any such policy for which a form or rate

is first filed on or after the effective date of this

section.

(2) For health insurance policies for which neither

rates nor forms are required to be filed with the Insurance

Department or the Federal Government, section 631.1 of the

act shall apply to any such policy issued or renewed on or

after 180 days after the effective date of this section.

Section 3. This act shall take effect immediately.

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