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Senate of Pennsylvania
Session of 2019 - 2020 Regular Session


Posted: December 27, 2018 12:12 PM
From: Senator Judy Ward
To: All Senate members
Subject: Stage IV Metastatic Cancer Coverage

I plan to introduce legislation that was originally introduced last session by Representative Matthew Baker as House Bill 1280 that would 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. Passage of this legislation will ensure that Stage IV metastatic cancer patients have access to the medicines and therapy prescribed by their doctors without delay, regardless of what their insurance typically covers.

Similar legislation has been enacted in 6 states (Georgia (2016), Maryland (2017), Connecticut (2017), Delaware (2017), Colorado (2018) and Illinois (2018)). The bill is supported by the American Cancer Society Cancer Action Network, International Cancer Advocacy Network, Prostate Health Education Network, Pennsylvania Prostate Cancer Coalition, Community Oncology Alliance, Pennsylvania Society of Oncology & Hematology, National Organization for Rare Disorders, American Society of Clinical Oncology, Pennsylvania Society of Gastroenterology, Susan G. Komen For the Cure Northeastern Pennsylvania, Malecare: Men Fighting Cancer Together, LUNGevity, and the Pennsylvania Medical Society.

This will be a companion bill to Representative Kerry Benninghoff’s proposal. During the 2017-18 legislative session, HB 1280 was approved by the House of Representatives.

Please join me in putting critical medical decisions back in the hands of doctors and Pennsylvania’s late-stage cancer patients.

Introduced as SB66