THE GENERAL ASSEMBLY OF PENNSYLVANIA

HOUSE BILL

INTRODUCED BY BURNS, DeLUCA, BELFANTI, BISHOP, BOBACK, BRADFORD, BRIGGS, D. COSTA, DONATUCCI, FRANKEL, FREEMAN, GALLOWAY, GERBER, GOODMAN, GRUCELA, HALUSKA, HARHART, HENNESSEY, HESS, HORNAMAN, JOHNSON, JOSEPHS, KORTZ, KULA, MAHONEY, McGEEHAN, MURPHY, PALLONE, PHILLIPS, QUINN, READSHAW, REICHLEY, SABATINA, SANTONI, SIPTROTH, K. SMITH, SOLOBAY, R. TAYLOR, WALKO, YOUNGBLOOD, MENSCH, MURT, GIBBONS, BOYLE, HOUGHTON AND WAGNER, JULY 16, 2009

AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES, JUNE 9, 2010   

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," providing for oncology benefit

design.

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.  Oncology Benefit Design.--(a)  Individual or

group health insurance policies offered by an insurer providing

coverage for intravenously administered cancer chemotherapy that

also provide coverage for orally administered cancer

chemotherapy shall provide orally administered cancer

chemotherapy with no less favorable patient cost-sharing than

for covered intravenously administered chemotherapy.

This shall include copayments, deductibles, coinsurance

provisions and maximum out-of-pocket limits that are based upon

how the chemotherapy is administered to the patient.

(b)  This section shall apply to individual or group health

insurance policies offered by an insurer that may offer coverage

for orally administered or injected chemotherapy as part of a

prescription drug benefit. This shall include offerings made

directly through the insurer or an entity that insurer has

contracted with to provide, deliver, arrange for or reimburse

for coverage.

(c)  Compliance with this section cannot be achieved by

imposing an increase in patient cost increases to patients for

<--

their out-of-pocket costs for currently those patients currently

<--

receiving covered chemotherapy agents regardless of the form of

administration.

(d)  This section shall apply to health insurance policies

offered, issued or renewed on or after July 1, 2011, in this

Commonwealth. This section shall not include the following

policies:

(1)  Accident only.

(2)  Fixed indemnity.

(3)  Limited benefit.

(4)  Credit.

(5)  Dental.

(6)  Vision.

(7)  Medicare supplement.

(8)  CHAMPUS (Civilian Health and Medical Program of the

Uniformed Services) supplement.

(9)  Long-term care or disability income.

(10)  Long-term care.

(11)  Workers' compensation.

(12)  Automobile medical payment.

(e)  The term "cancer chemotherapy" when used in this section

means medication that is prescribed by a physician for the

purpose of killing or slowing the growth of cancer cells.

(f)  The term "insurer" when used in this section means a

company or health insurance entity licensed in this Commonwealth

to issue individual or group health, sickness or accident policy

or subscriber contract or certificate or plan that provides

medical or health care coverage by a health care facility or

licensed health care provider that is offered or governed under

this act or the following:

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

as the "Health Maintenance Organization Act."

(2)  The act of May 18, 1976 (P.L.123, No.54), known as the

"Individual Accident and Sickness Insurance Minimum Standards

Act."

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

corporations) or 63 (relating to professional health services

plan corporations).

Section 2.  This act shall take effect July 1, 2011.