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PRINTER'S NO. 38
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No.
66
Session of
2019
INTRODUCED BY J. WARD, MENSCH, K. WARD, PHILLIPS-HILL, COSTA,
HUTCHINSON, COLLETT, TARTAGLIONE, SCHWANK, DINNIMAN,
SANTARSIERO AND LAUGHLIN, JANUARY 14, 2019
REFERRED TO BANKING AND INSURANCE, JANUARY 14, 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." A policyholder, subscriber, covered person or
other individual who is entitled to receive health care services
under a health insurance plan.
"Health insurance carrier." An entity that offers or issues
a health insurance plan and is subject to any of the following:
(1) The act of May 17, 1921 (P.L.682, No.284), known as
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The Insurance Company Law of 1921.
(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." A policy, contract, certificate or
agreement offered or issued by a health insurance carrier to
provide for the costs of 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.
"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 that,
directly or indirectly, covers the treatment of stage four,
advanced metastatic cancer shall not require an enrollee to
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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 drug:
(1) approved by the United States Food and Drug
Administration; and
(2) the use of which is consistent with the best
practices for the treatment 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.
Section 5. Effective date.
This act shall take effect in 60 days.
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