PRINTER'S NO. 1876
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1594
Session of
2023
INTRODUCED BY OTTEN, MADDEN, T. DAVIS, HANBIDGE, DONAHUE, KHAN,
SANCHEZ, BOROWSKI AND CERRATO, AUGUST 7, 2023
REFERRED TO COMMITTEE ON INSURANCE, AUGUST 7, 2023
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, providing
for coverage for biomarker testing.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.9. Coverage for Biomarker Testing.--(a) A
health insurance policy offered, issued or renewed in this
Commonwealth or a government program shall provide coverage for
genetic or molecular testing for cancer, including tumor
mutation testing, next generation sequencing, hereditary
germline mutation testing, pharmacogenomic testing, whole exome
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and genome sequencing and biomarker testing. Testing under this
subsection shall be covered in a manner that provides the most
complete range of results to a patient's health care provider
without requiring multiple biopsies or biospecimen samples. The
minimum coverage required under this subsection shall include
all costs associated with genetic or molecular testing for
cancer for the purpose of diagnosis, treatment, appropriate
management or ongoing monitoring of a patient's disease or
condition when the testing is medically necessary, including
labeled indications for diagnostic tests to direct treatment
decisions that are approved or authorized by the United States
Food and Drug Administration or indicated diagnostics tests for
a drug that is approved by the United States Food and Drug
Administration.
(b) Within one year of the effective date of this
subsection, the Legislative Budget and Finance Committee shall
report to the Banking and Insurance Committee of the Senate and
the Insurance Committee of the House of Representatives on the
impact of providing coverage for genetic or molecular testing
for cancer under subsection (a) of this section, including an
analysis of the impact of providing access to genetic or
molecular testing for cancer to individuals based on race,
gender, age and government program or health insurance policy.
(c) As used in this section:
"Biomarker" means a characteristic that is objectively
measured and evaluated as an indicator of normal biological
processes, pathogenic processes or pharmacologic responses to a
specific therapeutic intervention. The term includes gene
mutations or protein expression.
"Biomarker testing" means the analysis of a patient's tissue,
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blood or fluid biospecimen for the presence of a biomarker.
Biomarker testing includes, but is not limited to, single-
analyte tests, multiplex panel tests and partial or whole
genome, whole exome and whole transcriptome sequencing.
"Government program" means a program of government sponsored
or subsidized health care coverage, including:
(1) The children's health insurance program under Article
XXIII-A.
(2) The Commonwealth's medical assistance program under
subdivision (f) of Article IV of the act of June 13, 1967
(P.L.31, No.21), known as the "Human Services Code."
"Health insurance policy" means an individual or group
insurance policy, subscriber contract, certificate or plan
issued by an insurer that provides medical or health care
coverage, including emergency services. The term does not
include any of the following:
(1) An accident only policy.
(2) A credit only policy.
(3) A long-term care or disability income policy.
(4) A specified disease policy.
(5) A Medicare supplement policy.
(6) A fixed indemnity policy.
(7) A hospital indemnity policy.
(8) A dental only policy.
(9) A vision only policy.
(10) A worker's compensation policy.
(11) An automobile medical payment policy.
(12) A TRICARE policy, including a Civilian Health and
Medical Program of the Uniformed Services (CHAMPUS) supplement
policy.
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(13) Any other similar policy providing for limited
benefits.
"Insurer" means an entity licensed by the Insurance
Department with accident and health authority to issue a health
insurance policy that is offered or governed under any of the
following:
(1) This act, including section 630 and Article XXIV.
(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).
Section 2. This act shall take effect in 60 days.
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