House Bill 427, introduced by Representative Kerry Benninghoff (R-Centre/Mifflin) would require health insurance companies to approve prescribed treatments for patients with stage IV metastatic cancer regardless of what the insurance typically covers.
The bill was signed by the House on Wednesday after being amended in some minor ways, then unanimously approved by the Senate.
The bill is expected to be signed into law by the governor within the next ten days; it would then go into effect 60 days after the governor's approval.
“Those battling late-stage cancer should not have to jump through hoops or be delayed in getting the treatments prescribed by their doctors,” said Benninghoff. “They should have access to the best proven treatments available.”
Under current law, insurance companies have the ability to set coverage guidelines that govern how and when treatments are approved. Sometimes those guidelines require Stage IV patients to “fail first,” meaning they must first try an insurance-mandated series of medications that may fail to improve the condition before being granted access to the oncology medication and treatments prescribed by their doctor.
Senator Judy Ward (R-30), sponsor of companion bill Senate Bill 66, worked hand-in-hand with Benninghoff to get this policy change through the Legislature.
“Patients no longer will have to first demonstrate that they failed to respond to a different drug or drugs before they are provided coverage,” Ward said. “Metastatic patients experience an expansion of their cancer to new parts and organs in the body and for them, time is of the essence and delays in treatment are matters of life and death. I am proud to be a part of this important legislation that will offer help to all those survivors and their families.”
Benninghoff is the chairman of the Bipartisan House Cancer Caucus. Ward, a registered nurse, serves as chair of the Senate Aging and Youth Committee.
“Time is everything for those facing stage IV metastatic cancer,” Benninghoff said. “We shouldn’t require very sick cancer patients, who are in the fight of their lives, to get sicker and sicker before they are given access to treatment that may help them improve,” Benninghoff said.
House Bill 427 is supported by the American Cancer Society/Cancer Action Network Pennsylvania, American Society of Clinical Oncology, Cancer Support Community, Community Oncology Alliance, Lungevity, National Organization of Rare Disorders, Pennsylvania Medical Society, Pennsylvania Prostate Cancer Coalition, Pennsylvania Society of Gastroenterology, Pennsylvania Society of Oncology & Hematology, and Susan G. Komen for the Cure.