Bill Text: FL S1392 | 2021 | Regular Session | Introduced


Bill Title: Health Insurance Coverage for Cancer Treatment

Spectrum: Partisan Bill (Republican 1-0)

Status: (Failed) 2021-04-30 - Died in Banking and Insurance [S1392 Detail]

Download: Florida-2021-S1392-Introduced.html
       Florida Senate - 2021                                    SB 1392
       
       
        
       By Senator Harrell
       
       
       
       
       
       25-01462-21                                           20211392__
    1                        A bill to be entitled                      
    2         An act relating to health insurance coverage for
    3         cancer treatment; amending s. 627.4239, F.S.; defining
    4         the terms “associated condition” and “health care
    5         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 has failed with a different
   12         drug; providing applicability; prohibiting insurers
   13         and health maintenance organizations from excluding
   14         coverage for certain drugs on certain grounds;
   15         prohibiting insurers and health maintenance
   16         organizations from requiring that certain cancer
   17         treatment drugs be sent to certain entities for home
   18         infusion unless a certain condition is met; revising
   19         construction; providing an effective date.
   20          
   21  Be It Enacted by the Legislature of the State of Florida:
   22  
   23         Section 1. Section 627.4239, Florida Statutes, is amended
   24  to read:
   25         627.4239 Coverage for use of drugs in treatment of cancer.—
   26         (1) DEFINITIONS.—As used in this section, the term:
   27         (a) “Associated condition” means a symptom or side effect
   28  that:
   29         1.Is associated with a particular cancer at a particular
   30  stage or with the treatment of that cancer; and
   31         2.In the judgment of a health care provider, will further
   32  jeopardize the health of a patient if left untreated. As used in
   33  this subparagraph, the term “health care provider” means a
   34  physician licensed under chapter 458, chapter 459, or chapter
   35  461, a physician assistant licensed under chapter 458 or chapter
   36  459, an advanced practice registered nurse licensed under
   37  chapter 464, or a dentist licensed under chapter 466.
   38         (b) “Medical literature” means scientific studies published
   39  in a United States peer-reviewed national professional journal.
   40         (c)(b) “Standard reference compendium” means authoritative
   41  compendia identified by the Secretary of the United States
   42  Department of Health and Human Services and recognized by the
   43  federal Centers for Medicare and Medicaid Services.
   44         (2) COVERAGE FOR TREATMENT OF CANCER.—
   45         (a) An insurer or a health maintenance organization may not
   46  exclude coverage in any individual or group health insurance
   47  policy or health maintenance contract issued, amended,
   48  delivered, or renewed in this state which covers the treatment
   49  of cancer for any drug prescribed for the treatment of cancer on
   50  the ground that the drug is not approved by the United States
   51  Food and Drug Administration for a particular indication, if
   52  that drug is recognized for treatment of that indication in a
   53  standard reference compendium or recommended in the medical
   54  literature.
   55         (b)Coverage for a drug required by this section also
   56  includes the medically necessary services associated with the
   57  administration of the drug.
   58         (3)COVERAGE FOR TREATMENT OF STAGE 4 METASTATIC CANCER AND
   59  ASSOCIATED CONDITIONS.—
   60         (a)An insurer or a health maintenance organization may not
   61  require in any individual or group health insurance policy or
   62  health maintenance contract issued, amended, delivered, or
   63  renewed in this state which covers the treatment of stage 4
   64  metastatic cancer and its associated conditions that, before a
   65  drug prescribed for the treatment is covered, the insured or
   66  subscriber fail or have previously failed to respond
   67  successfully to a different drug.
   68         (b)Paragraph (a) applies to a drug that is recognized for
   69  the treatment of such stage 4 metastatic cancer or its
   70  associated conditions, as applicable, in a standard reference
   71  compendium or that is recommended in the medical literature. The
   72  insurer or health maintenance organization may not exclude
   73  coverage for such drug on the ground that the drug is not
   74  approved by the United States Food and Drug Administration for
   75  such stage 4 metastatic cancer or its associated conditions, as
   76  applicable.
   77         (4)COVERAGE FOR SERVICES ASSOCIATED WITH DRUG
   78  ADMINISTRATION.—Coverage for a drug required by this section
   79  also includes the medically necessary services associated with
   80  the administration of the drug.
   81         (5)PROHIBITION ON MANDATORY HOME INFUSION.—An insurer or a
   82  health maintenance organization may not require that a cancer
   83  medication be administered using home infusion, and may not
   84  require that such medication be sent directly to a third party
   85  or to the patient for home infusion unless the patient’s
   86  treating oncologist determines that home infusion of the cancer
   87  medication will not jeopardize the health of the patient.
   88         (6)(3) APPLICABILITY AND SCOPE.—This section may not be
   89  construed to:
   90         (a) Alter any other law with regard to provisions limiting
   91  coverage for drugs that are not approved by the United States
   92  Food and Drug Administration, except for drugs for the treatment
   93  of stage 4 metastatic cancer or its associated conditions.
   94         (b) Require coverage for any drug, except for a drug for
   95  the treatment of stage 4 metastatic cancer or its associated
   96  conditions, if the United States Food and Drug Administration
   97  has determined that the use of the drug is contraindicated.
   98         (c) Require coverage for a drug that is not otherwise
   99  approved for any indication by the United States Food and Drug
  100  Administration, except for a drug for the treatment of stage 4
  101  metastatic cancer or its associated conditions.
  102         (d) Affect the determination as to whether particular
  103  levels, dosages, or usage of a medication associated with bone
  104  marrow transplant procedures are covered under an individual or
  105  group health insurance policy or health maintenance organization
  106  contract.
  107         (e) Apply to specified disease or supplemental policies.
  108         (f)(4)Nothing in this section is intended, Expressly or by
  109  implication, to create, impair, alter, limit, modify, enlarge,
  110  abrogate, prohibit, or withdraw any authority to provide
  111  reimbursement for drugs used in the treatment of any other
  112  disease or condition.
  113         Section 2. This act shall take effect January 1, 2022.

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