PRIORS0066B0038A01800 PRINTER'SPWK:EJH 06/10/19 #90 A01800 AMENDMENTS TO SENATE BILL NO.

3866 PRINTER'SSponsor: NO.

926SENATOR THESCAVELLO GENERALPrinter's ASSEMBLY OF PENNSYLVANIA SENATE BILL Session of No.

6638 2019Amend INTRODUCEDBill, BYpage J.1, line 14, by striking out "plan" and inserting policy Amend Bill, page 1, line 16, by striking out "plan" and inserting policy Amend Bill, page 2, line 1, by inserting after "1921" , including section 630 and Article XXIV of The Insurance Company Law of 1921 Amend Bill, page 2, line 7, by striking out "plan" and inserting policy Amend Bill, page 2, line 8, by striking out "or issued" and inserting , issued or renewed Amend Bill, page 2, line 9, by striking out "for the costs of" and inserting coverage for Amend Bill, page 2, by inserting between lines 22 and 23 (12) Hospital indemnity.

WARD,(13) MENSCH,Medicare K.supplement.

WARD,Amend PHILLIPS-HILL,Bill, COSTA,page HUTCHINSON,2, COLLETT,line TARTAGLIONE,28, SCHWANK,by DINNIMAN,striking SANTARSIERO,out LAUGHLIN,"plan" REGAN,and BREWSTERinserting ANDpolicy KILLION,Amend JANUARYBill, 14,page 20192, SENATORline SCAVELLO,30, BANKINGby ANDstriking INSURANCE,out AS"shall" AMENDED,and JUNE2019/90PWK/SB0066A01800 10,- 20191 AN- ACTinserting Providingmay forAmend healthBill, page 3, line 3, by inserting after "a" covered Amend Bill, page 3, line 3, by inserting after "drug" to which both of the following apply Amend Bill, page 3, line 4, by inserting after "(1) " the drug is Amend Bill, page 3, line 6, by striking out "which is consistent" and inserting the drug is consistent with its FDA-approved indication and Amend Bill, page 3, line 6, by inserting after "best" clinical Amend Bill, page 3, lines 10 and 11, by striking out "to insurance coverageplans requirementsissued, fordelivered stageor" four,in advancedline metastatic10 cancer.and all of line 11 and inserting as follows:

The(1) GeneralFor Assemblya ofhealth insurance policy for which either rates or forms are required to be filed with the CommonwealthFederal ofGovernment Pennsylvaniaor herebythe enactsInsurance asDepartment, follows:this act shall apply to any policy for which a rate or form is first filed on or after 180 days after the effective date of this act.

Section(2) 1.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.

Short2019/90PWK/SB0066A01800 title.- 2 -

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 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 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 POLICY." A policy, contract, <-- certificate or agreement offered or issued, 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.

(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 20190SB0066PN0926 - 2 - 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;