Florida Senate - 2021 SB 1392 By Senator Harrell 25-01462-21 20211392__ Page 1 of 4 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1

An act relating to health insurance coverage for 2 cancer treatment; amending s. 627.4239, F.S.; defining 3 the terms “associated condition” and “health care 4 provider”; prohibiting health maintenance 5 organizations from excluding coverage for certain 6 cancer treatment drugs; prohibiting health insurers 7 and health maintenance organizations from requiring, 8 before providing prescription drug coverage for the 9 treatment of stage 4 metastatic cancer and associated 10 conditions, that treatment has failed with a different 11 drug; providing applicability; prohibiting insurers 12 and health maintenance organizations from excluding 13 coverage for certain drugs on certain grounds; 14 prohibiting insurers and health maintenance 15 organizations from requiring that certain cancer 16 treatment drugs be sent to certain entities for home 17 infusion unless a certain condition is met; revising 18 construction; providing an effective date. 19 20 Be It Enacted by the Legislature of the State of Florida: 21 22

Section

Section 627.4239, Florida Statutes, is amended 23 to read: 24 627.4239 Coverage for use of drugs in treatment of cancer.— 25

(1) DEFINITIONS.—As used in this section, the term: 26 (a) “Associated condition” means a symptom or side effect 27 that: 28 1. Is associated with a particular cancer at a particular 29 Florida Senate - 2021 SB 1392 25-01462-21 20211392__ Page 2 of 4 CODING: Words stricken are deletions; words underlined are additions. stage or with the treatment of that cancer; and 30 2. In the judgment of a health care provider, will further 31 jeopardize the health of a patient if left untreated. As used in 32 this subparagraph, the term “health care provider” means a 33 physician licensed under

chapter 458,

chapter 459, or

chapter 34 461, a physician assistant licensed under

chapter 458 or

chapter 35 459, an advanced practice registered nurse licensed under 36

chapter 464, or a dentist licensed under

chapter 466. 37 (b) “Medical literature” means scientific studies published 38 in a United States peer-reviewed national professional journal. 39 (c)(b) “Standard reference compendium” means authoritative 40 compendia identified by the Secretary of the United States 41 Department of Health and Human Services and recognized by the 42 federal Centers for Medicare and Medicaid Services. 43

(2) COVERAGE FOR TREATMENT OF CANCER.— 44 (

a) An insurer or a health maintenance organization may not 45 exclude coverage in any individual or group health insurance 46 policy or health maintenance contract issued, amended, 47 delivered, or renewed in this state which covers the treatment 48 of cancer for any drug prescribed for the treatment of cancer on 49 the ground that the drug is not approved by the United States 50 Food and Drug Administration for a particular indication, if 51 that drug is recognized for treatment of that indication in a 52 standard reference compendium or recommended in the medical 53 literature. 54 (

b) Coverage for a drug required by this

section also 55 includes the medically necessary services associated with the 56 administration of the drug. 57

(3) COVERAGE FOR TREATMENT OF STAGE 4 METASTATIC CANCER AND 58 Florida Senate - 2021 SB 1392 25-01462-21 20211392__ Page 3 of 4 CODING: Words stricken are deletions; words underlined are additions. ASSOCIATED CONDITIONS.— 59 (

a) An insurer or a health maintenance organization may not 60 require in any individual or group health insurance policy or 61 health maintenance contract issued, amended, delivered, or 62 renewed in this state which covers the treatment of stage 4 63 metastatic cancer and its associated conditions that, before a 64 drug prescribed for the treatment is covered, the insured or 65 subscriber fail or have previously failed to respond 66 successfully to a different drug. 67 (

b) Paragraph (

a) applies to a drug that is recognized for 68 the treatment of such stage 4 metastatic cancer or its 69 associated conditions, as applicable, in a standard reference 70 compendium or that is recommended in the medical literature. The 71 insurer or health maintenance organization may not exclude 72 coverage for such drug on the ground that the drug is not 73 approved by the United States Food and Drug Administration for 74 such stage 4 metastatic cancer or its associated conditions, as 75 applicable. 76

(4) COVERAGE FOR SERVICES ASSOCIATED WITH DRUG 77 ADMINISTRATION.—Coverage for a drug required by this

section 78 also includes the medically necessary services associated with 79 the administration of the drug. 80

(5) PROHIBITION ON MANDATORY HOME INFUSION.—An insurer or a 81 health maintenance organization may not require that a cancer 82 medication be administered using home infusion, and may not 83 require that such medication be sent directly to a third party 84 or to the patient for home infusion unless the patient’s 85 treating oncologist determines that home infusion of the cancer 86 medication will not jeopardize the health of the patient. 87 Florida Senate - 2021 SB 1392 25-01462-21 20211392__ Page 4 of 4 CODING: Words stricken are deletions; words underlined are additions. (6)

(3) APPLICABILITY AND SCOPE.—This

section may not be 88 construed to: 89 (

a) Alter any other law with regard to provisions limiting 90 coverage for drugs that are not approved by the United States 91 Food and Drug Administration, except for drugs for the treatment 92 of stage 4 metastatic cancer or its associated conditions. 93 (

b) Require coverage for any drug, except for a drug for 94 the treatment of stage 4 metastatic cancer or its associated 95 conditions, if the United States Food and Drug Administration 96 has determined that the use of the drug is contraindicated. 97 (

c) Require coverage for a drug that is not otherwise 98 approved for any indication by the United States Food and Drug 99 Administration, except for a drug for the treatment of stage 4 100 metastatic cancer or its associated conditions. 101 (

d) Affect the determination as to whether particular 102 levels, dosages, or usage of a medication associated with bone 103 marrow transplant procedures are covered under an individual or 104 group health insurance policy or health maintenance organization 105 contract. 106 (

e) Apply to specified disease or supplemental policies. 107 (f)

(4) Nothing in this

section is intended, Expressly or by 108 implication, to create, impair, alter, limit, modify, enlarge, 109 abrogate, prohibit, or withdraw any authority to provide 110 reimbursement for drugs used in the treatment of any other 111 disease or condition. 112

Section 2. This act shall take effect January 1, 2022. 113