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House of Representatives
Session of 2019 - 2020 Regular Session


Posted: January 28, 2019 11:12 AM
From: Representative Kerry A. Benninghoff
To: All House members
Subject: Stage IV Metastic Cancer Coverage (Formber HB 1280)
In the near future, I plan to reintroduce necessary legislation to grant Stage IV Metastatic cancer patients access to the medication and treatments prescribed by their doctors.

The measure, known as the Fair Access to Cancer Treatment Act, provides that health plans covering treatments for Stage IV, metastatic cancers would be prohibited from excluding or limiting drugs for patients if the drugs are FDA approved and consistent with best practices for Stage IV, metastatic cancer treatment. Specifically, a patient with Stage IV advanced metastatic cancer cannot be required to first fail on one drug before an insurance plan will cover the use of a different drug, so long as it meets the criteria above.

Insurers currently have the ability to set coverage guidelines that govern how and when treatments are approved. These guidelines sometimes require Stage IV patients to first try an insurance-mandated series of medicines that fail to improve the condition before the insurer will cover advanced therapies prescribed by their doctor. They are often referred to as “step therapy” or “fail first” policies.

By definition, metastatic patients are experiencing an expansion of their cancer to new parts and organs in the body. Time is of the essence for these vulnerable patients – and delays in treatment are matters of life and death.

A similar measure, The Hon. Jimmy Carter Cancer Treatment Access Act, was signed into law by Governor Nathan Deal in 2016 with unanimous, bipartisan support. To date, similar legislation has been enacted in six states.

I hope you will join me in putting critical medical decisions back in the hands of doctors and Pennsylvania’s late-stage cancer patients. This legislation passed the House last session unanimously.

Introduced as HB427