SENATE AMENDED
PRIOR PRINTER'S NOS. 414, 1089, 2194
PRINTER'S NO. 2901
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, DeLUCA, GLEIM, KORTZ, KINSEY, KENYATTA AND
HOHENSTEIN, FEBRUARY 11, 2019
SENATOR SCAVELLO, BANKING AND INSURANCE, IN SENATE, AS AMENDED,
NOVEMBER 19, 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:
"Enrollee." Any policyholder, subscriber, covered person or
other individual who is entitled to receive health care services
under a health insurance policy.
"Health insurance carrier." An entity that offers or issues
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a health insurance 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 policy." A policy, contract, certificate
or agreement offered, issued or renewed by a health insurance
carrier to provide 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.
(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
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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 policy that,
directly or indirectly, covers the treatment of stage four,
advanced metastatic cancer 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 prescription of the drug is consistent with the
best clinical practices for the treatment of stage four,
advanced metastatic cancer or a severe adverse health
condition experienced as a result of stage four, advanced
metastatic cancer, AND IS SUPPORTED BY PEER-REVIEWED MEDICAL
LITERATURE.
Section 4. Applicability.
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 effective date of this 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 effective date of this act.
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Section 5. Effective date.
This act shall take effect in 60 days.
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