Bill Text: FL S0672 | 2020 | Regular Session | Introduced
Bill Title: Coverage for Cancer and Associated Conditions Drug Treatment
Spectrum: Bipartisan Bill
Status: (Failed) 2020-03-14 - Died in Banking and Insurance [S0672 Detail]
Download: Florida-2020-S0672-Introduced.html
Florida Senate - 2020 SB 672
By Senator Mayfield
17-00714-20 2020672__
1 A bill to be entitled
2 An act relating to coverage for cancer and associated
3 conditions drug treatment; amending s. 627.4239, F.S.;
4 defining the terms “associated condition” and “health
5 care provider”; prohibiting health maintenance
6 organizations from excluding coverage for certain
7 cancer treatment drugs; prohibiting health insurers
8 and health maintenance organizations from requiring,
9 before providing prescription drug coverage for the
10 treatment of stage 4 metastatic cancer and associated
11 conditions, that treatment have failed with a
12 different drug; providing applicability; prohibiting
13 insurers and health maintenance organizations from
14 excluding coverage for certain drugs on certain
15 grounds; providing an effective date.
16
17 Be It Enacted by the Legislature of the State of Florida:
18
19 Section 1. Section 627.4239, Florida Statutes, is amended
20 to read:
21 627.4239 Coverage for use of drugs in treatment of cancer.—
22 (1) DEFINITIONS.—As used in this section, the term:
23 (a) “Associated condition” means a symptom or side effect
24 that:
25 1. Is associated with a particular cancer at a particular
26 stage or with the treatment of that cancer; and
27 2. In the judgment of a health care provider, will further
28 jeopardize the health of a patient if left untreated. As used in
29 this subparagraph, the term “health care provider” means a
30 physician licensed under chapter 458, chapter 459, or chapter
31 461, a physician assistant licensed under chapter 458 or chapter
32 459, an advanced practice registered nurse licensed under
33 chapter 464, or a dentist licensed under chapter 466.
34 (b)(a) “Medical literature” means scientific studies
35 published in a United States peer-reviewed national professional
36 journal.
37 (c)(b) “Standard reference compendium” means authoritative
38 compendia identified by the Secretary of the United States
39 Department of Health and Human Services and recognized by the
40 federal Centers for Medicare and Medicaid Services.
41 (2) COVERAGE FOR TREATMENT OF CANCER.—
42 (a) An insurer or a health maintenance organization may not
43 exclude coverage in any individual or group health insurance
44 policy or health maintenance contract issued, amended,
45 delivered, or renewed in this state which covers the treatment
46 of cancer for any drug prescribed for the treatment of cancer on
47 the ground that the drug is not approved by the United States
48 Food and Drug Administration for a particular indication, if
49 that drug is recognized for treatment of that indication in a
50 standard reference compendium or recommended in the medical
51 literature.
52 (b) Coverage for a drug required by this section also
53 includes the medically necessary services associated with the
54 administration of the drug.
55 (3) COVERAGE FOR TREATMENT OF STAGE 4 METASTATIC CANCER AND
56 ASSOCIATED CONDITIONS.—
57 (a) An insurer or a health maintenance organization may not
58 require in any individual or group health insurance policy or
59 health maintenance contract issued, amended, delivered, or
60 renewed in this state which covers the treatment of stage 4
61 metastatic cancer and its associated conditions that, before a
62 drug prescribed for the treatment is covered, the insured or
63 subscriber fail or have previously failed to respond
64 successfully to a different drug.
65 (b) Paragraph (a) applies to a drug that is recognized for
66 the treatment of such stage 4 metastatic cancer or its
67 associated conditions, as applicable, in a standard reference
68 compendium or that is recommended in the medical literature. The
69 insurer or health maintenance organization may not exclude
70 coverage for such drug on the ground that the drug is not
71 approved by the United States Food and Drug Administration for
72 such stage 4 metastatic cancer or its associated conditions, as
73 applicable.
74 (4) COVERAGE FOR SERVICES ASSOCIATED WITH DRUG
75 ADMINISTRATION.—Coverage for a drug required by this section
76 also includes the medically necessary services associated with
77 the administration of the drug.
78 (5)(3) APPLICABILITY AND SCOPE.—This section may not be
79 construed to:
80 (a) Alter any other law with regard to provisions limiting
81 coverage for drugs that are not approved by the United States
82 Food and Drug Administration.
83 (b) Require coverage for any drug if the United States Food
84 and Drug Administration has determined that the use of the drug
85 is contraindicated.
86 (c) Require coverage for a drug that is not otherwise
87 approved for any indication by the United States Food and Drug
88 Administration.
89 (d) Affect the determination as to whether particular
90 levels, dosages, or usage of a medication associated with bone
91 marrow transplant procedures are covered under an individual or
92 group health insurance policy or health maintenance organization
93 contract.
94 (e) Apply to specified disease or supplemental policies.
95 (f)(4) Nothing in this section is intended, Expressly or by
96 implication, to create, impair, alter, limit, modify, enlarge,
97 abrogate, prohibit, or withdraw any authority to provide
98 reimbursement for drugs used in the treatment of any other
99 disease or condition.
100 Section 2. This act shall take effect January 1, 2021.
