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.