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| THE GENERAL ASSEMBLY OF PENNSYLVANIA |
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| SENATE BILL |
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| INTRODUCED BY GREENLEAF, ALLOWAY, BREWSTER, WASHINGTON AND LEACH, APRIL 13, 2011 |
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| REFERRED TO BANKING AND INSURANCE, APRIL 13, 2011 |
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| AN ACT |
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1 | Requiring health insurance policies to provide coverage for |
2 | tobacco cessation programs and drugs. |
3 | The General Assembly of the Commonwealth of Pennsylvania |
4 | hereby enacts as follows: |
5 | Section 1. Short title. |
6 | This act shall be known and may be cited as the Tobacco |
7 | Cessation Treatment Act. |
8 | Section 2. Findings. |
9 | The General Assembly finds and declares as follows: |
10 | (1) Providing tobacco cessation counseling and |
11 | medication is one of the most clinically effective and cost- |
12 | effective health services available, according to the |
13 | National Commission on Prevention Priorities. Tobacco |
14 | cessation is 5 to 80 times more cost effective than |
15 | pharmacologic interventions used to prevent heart attacks. |
16 | (2) More than 70% of smokers wish they could quit |
17 | tobacco and each year one of every two smokers attempts to |
18 | quit. However, the unassisted successful tobacco quit rate |
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1 | has remained constant at less than 5%. Access to counseling |
2 | and pharmaceutical benefits doubles the successful quit rate |
3 | and has achieved quit rates of 25% to 30%. Experience in |
4 | health plans indicates that access to all cessation services |
5 | saves $4 for every dollar invested. |
6 | (3) Each adult smoker costs employers $1,760 in lost |
7 | productivity and $1,623 in excess medical expenditures. Men |
8 | who smoke incur $15,800 more in lifetime medical expenses |
9 | than do men who do not smoke. For employers, the ultimate |
10 | financial return is between $5 and $6 for every dollar spent |
11 | on tobacco cessation. |
12 | (4) Because of member transfers between plans, financial |
13 | savings and tobacco-related disease reductions are effective |
14 | only if universally available to the entire insured |
15 | population. Therefore, a mandate on all plans and insurers to |
16 | provide cost-effective treatment is necessary and beneficial. |
17 | (5) It is the intent of the General Assembly that this |
18 | act diminish the Statewide economic and personal cost of |
19 | tobacco addiction by making tobacco cessation treatments |
20 | available to all smokers. Approximately 20,000 Pennsylvania |
21 | adults die annually, at a rate of 16%, from smoking-related |
22 | causes. Tobacco-related personal health care costs total |
23 | approximately $4.7 billion annually in Pennsylvania. |
24 | Section 3. Definitions. |
25 | The following words and phrases when used in this act shall |
26 | have the meanings given to them in this section unless the |
27 | context clearly indicates otherwise: |
28 | "Course of treatment." One of the following: |
29 | (1) In the case of counseling, treatment consisting of |
30 | at least four sessions of counseling lasting at least ten |
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1 | minutes. |
2 | (2) In the case of a prescription or over-the-counter |
3 | medication, the duration of treatment approved by the Food |
4 | and Drug Administration for that medication. |
5 | "Health insurance policy." |
6 | (1) An individual or group health insurance policy that |
7 | is delivered, issued for delivery, renewed, extended or |
8 | modified in this Commonwealth. |
9 | (2) The term does not include any of the following types |
10 | of insurance or a combination of any of the following types |
11 | of insurance: |
12 | (i) Short-term travel. |
13 | (ii) Accident-only. |
14 | (iii) Workers' compensation. |
15 | (iv) Short-term nonrenewable policies of not more |
16 | than six months' duration. |
17 | (v) Hospital indemnity. |
18 | (vi) Specified disease. |
19 | (vii) Disability income. |
20 | (viii) Dental. |
21 | (ix) Vision. |
22 | (x) Civilian Health and Medical Program of the |
23 | Uniformed Services (CHAMPUS) supplement. |
24 | (xi) Medicare or Medicaid supplemental contract. |
25 | (xii) Long-term care. |
26 | Section 4. Mandated coverage. |
27 | (a) General rule.--Every health insurance policy that is |
28 | delivered, issued for delivery, renewed, extended or modified in |
29 | this Commonwealth on or after the effective date of this section |
30 | shall provide for tobacco cessation services that follow |
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1 | recommendations in the Public Health Service-sponsored 2008 |
2 | clinical practice guideline, "Treating Tobacco Use and |
3 | Dependence: 2008 Update," or its successors. The coverage shall |
4 | include at least two courses of treatment in a 12-month period |
5 | including personal counseling, which may be telephone, group or |
6 | individual counseling, and all medications approved by the Food |
7 | and Drug Administration for the purpose of tobacco cessation, |
8 | including all prescription and over-the-counter medications. |
9 | (b) Copayment, coinsurance or deductible.--No copayment, |
10 | coinsurance or deductible may be applied to benefits under this |
11 | section. |
12 | (c) Contracting.--A health insurer may contract with |
13 | qualified local, Statewide or national providers, whether for |
14 | profit or nonprofit, for the provision of services under this |
15 | section. |
16 | (d) Disclosure.--An insurer shall disclose the benefits |
17 | under this section in its evidence of coverage and disclosure |
18 | forms and communicate the availability of coverage to all |
19 | insureds at least once per year. |
20 | (e) Counseling.--No patient may be required to enter |
21 | counseling in order to receive medications for tobacco cessation |
22 | treatment. |
23 | (f) Prior authorization.--No health care plan may impose |
24 | prior authorization or stepped care requirements on tobacco |
25 | cessation treatment. |
26 | Section 5. Effective date. |
27 | This act shall take effect in 60 days. |
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