PRINTER'S NO. 517
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
536
Session of
2015
INTRODUCED BY TOMLINSON, VANCE, GREENLEAF, YAW, FONTANA, MENSCH,
YUDICHAK, SCHWANK, BREWSTER, PILEGGI, KITCHEN, WARD,
VULAKOVICH, BOSCOLA, TARTAGLIONE, COSTA, FOLMER AND RAFFERTY,
FEBRUARY 25, 2015
REFERRED TO BANKING AND INSURANCE, FEBRUARY 25, 2015
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 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 Medications.--
(a) Whenever a health insurance policy provides coverage that
includes coverage for cancer chemotherapy or anticancer
medications which have been approved by the United States Food
and Drug Administration for general use in the treatment of
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cancer, the policy shall not provide coverage or impose cost
sharing for a prescribed, orally administered anticancer
medication on a less favorable basis than the coverage it
provides or cost sharing it imposes for intravenously
administered or injected cancer 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.
(c) The prohibitions in subsections (a) and (b) do not
preclude a health insurance policy from requiring an enrollee to
obtain prior authorization before orally administered anticancer
medication is dispensed to the enrollee.
(d) 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) As used in this section:
"Anticancer medication" means a drug or biological product
that is used to kill, slow or prevent 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.
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(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).
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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