SENATEH0427B1089A02230 AMENDEDAJB:AAS PRINTER'S06/19/19 #90 A02230 AMENDMENTS TO HOUSE BILL NO.

2901427 PRIORSponsor: PRINTER'S NOS.

414,REPRESENTATIVE 1089,BENNINGHOFF 2194Printer's THE GENERAL ASSEMBLY OF PENNSYLVANIA HOUSE BILL Session of 2019 No.

INTRODUCED1089 BYAmend BENNINGHOFF,Bill, BARRAR,page BERNSTINE,1, CALTAGIRONE,lines CAUSER,12 CIRESI,through T.15, by striking out all of said lines Amend Bill, page 2, by inserting after line 30 (12) Hospital indemnity.

DAVIS, DONATUCCI, FREEMAN, HERSHEY, LONGIETTI, McCLINTON, McNEILL, MILLARD, MURT, OBERLANDER, ZIMMERMAN, DeLUCA, GLEIM, KORTZ, KINSEY, KENYATTA ANDELAND, 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 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.

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SectionAmend 3.Bill, page 3, line 26, by striking out "DATE OF ENACTMENT" and inserting effective date Amend Bill, page 4, line 1, by striking out "DATE OF ENACTMENT" and inserting effective date 2019/90AJB/HB0427A02230 - 1 -

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.