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A02230
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
427
Session of
2019
INTRODUCED BY BENNINGHOFF, BARRAR, BERNSTINE, CALTAGIRONE,
CAUSER, CIRESI, T. DAVIS, DONATUCCI, FREEMAN, HERSHEY,
LONGIETTI, McCLINTON, McNEILL, MILLARD, MURT, OBERLANDER,
PICKETT, READSHAW, ROTHMAN, RYAN, SAYLOR, WARREN, WHEELAND,
ZIMMERMAN AND DeLUCA, FEBRUARY 11, 2019
AS REPORTED FROM COMMITTEE ON HEALTH, HOUSE OF REPRESENTATIVES,
AS AMENDED, MARCH 25, 2019
AN ACT
Providing for health insurance coverage requirements for stage
four, advanced metastatic cancer.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Short title.
This act shall be known and may be cited as the Fair Access
to Cancer Treatment Act.
Section 2. Definitions.
The following words and phrases when used in this act shall
have the meanings given to them in this section unless the
context clearly indicates otherwise:
"ASSOCIATED CONDITION." A SERIOUS CANCER-RELATED CONDITION
THAT, IN THE JUDGMENT OF THE HEALTH CARE PRACTITIONER, IS CAUSED
BY THE CANCER OR CANCER TREATMENT AND WHICH FURTHER JEOPARDIZES
THE HEALTH OF A PATIENT IF LEFT UNTREATED.
"Enrollee." Any policyholder, subscriber, covered person or
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other individual who is entitled to receive health care services
under a health insurance plan POLICY.
"Health insurance carrier." An entity that offers or issues
a health insurance plan POLICY and is subject to any of the
following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
The Insurance Company Law of 1921, INCLUDING SECTION 630 AND
ARTICLE XXIV OF THE 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
plan corporations).
"Health insurance plan POLICY." A policy, contract,
certificate or agreement offered or, issued OR RENEWED by a
health insurance carrier to provide for the costs of COVERAGE
FOR health care services. The term does not include the
following types of policies:
(1) Accident only.
(2) Limited benefit.
(3) Credit.
(4) Vision.
(5) Dental.
(6) Specified disease.
(7) Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS) supplement.
(8) Long-term care or disability income.
(9) Workers' compensation.
(10) Automobile medical payment.
(11) Fixed indemnity.
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(12) Hospital indemnity.
(13) Medicare supplement.
"Stage four, advanced metastatic cancer." Cancer that has
spread from the primary or original site of the cancer to nearby
tissues, lymph nodes or other areas or parts of the body.
Section 3. Utilization management for stage four, advanced
metastatic cancer drugs.
A health insurance carrier or health insurance plan POLICY
that, directly or indirectly, covers the treatment of stage
four, advanced metastatic cancer shall MAY not require an
enrollee to first fail to successfully respond to a different
drug, or prove a history of failure in use of a different drug,
before providing coverage for a covered drug to which BOTH OF
the following apply:
(1) The drug is approved by the United States Food and
Drug Administration FOR THIS INDICATION.
(2) The use prescription of the drug is consistent with
the best clinical practices for the treatment of stage four,
advanced metastatic cancer OR ASSOCIATED CONDITION. a severe
adverse health condition experienced as a result of stage
four, advanced metastatic cancer.
Section 4. Applicability.
This act shall apply to insurance plans issued, delivered or
renewed on or after the effective date of this section. THIS ACT
SHALL APPLY AS FOLLOWS:
(1) FOR A HEALTH INSURANCE POLICY FOR WHICH EITHER RATES
OR FORMS ARE REQUIRED TO BE FILED WITH THE FEDERAL GOVERNMENT
OR THE INSURANCE DEPARTMENT, THIS ACT SHALL APPLY TO ANY
POLICY FOR WHICH A FORM OR RATE IS FIRST FILED ON OR AFTER
180 DAYS AFTER THE DATE OF ENACTMENT effective date OF THIS
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ACT.
(2) FOR A HEALTH INSURANCE POLICY FOR WHICH NEITHER
RATES NOR FORMS ARE REQUIRED TO BE FILED WITH THE FEDERAL
GOVERNMENT OR THE INSURANCE DEPARTMENT, THIS ACT SHALL APPLY
TO ANY POLICY ISSUED OR RENEWED ON OR AFTER 180 DAYS AFTER
THE DATE OF ENACTMENT effective date OF THIS ACT.
Section 5. Effective date.
This act shall take effect in 60 days.
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