PRINTER'S NO. 2363
No. 1903 Session of 1999
INTRODUCED BY L. I. COHEN, ARGALL, BEBKO-JONES, DALEY,
GIGLIOTTI, JOSEPHS, LAUGHLIN, MAITLAND, ORIE, SATHER,
SEYFERT, STERN, WASHINGTON AND YOUNGBLOOD, OCTOBER 4, 1999
REFERRED TO COMMITTEE ON HEALTH AND HUMAN SERVICES,
OCTOBER 4, 1999
AN ACT
1 Relating to the temporary extension of long-term medication
2 prescriptions.
3 The General Assembly of the Commonwealth of Pennsylvania
4 hereby enacts as follows:
5 Section 1. Definitions.
6 The following words and phrases when used in this act shall
7 have the meanings given to them in this section unless the
8 context clearly indicates otherwise:
9 "Insurance carrier." An insurance company, health service
10 corporation, managed care organization, hospital or medical
11 service corporation, or health maintenance organization
12 authorized to issue health benefits plans, or a prepaid
13 prescription service organization authorized to issue prepaid
14 prescription plans in this Commonwealth.
15 "Prescription medications." A legend drug other than
16 controlled substances and also includes diabetic testing
17 materials, insulin, insulin syringes and insulin needles.
1 Section 2. Medication extension.
2 Notwithstanding the provisions of any other statute or
3 regulation to the contrary, a health care professional lawfully
4 prescribing or authorizing a refill of a prescription for any
5 prescription medication during the period from December 1, 1999,
6 through December 31, 1999, shall, upon the request of the
7 patient, prescribe or authorize a refill for a supply of the
8 medication which is sufficient to continue the treatment at
9 least until January 31, 2000, provided that the prescriber:
10 (1) has determined that the patient's condition for
11 which the medication is prescribed as treatment for the
12 patient's condition at least until January 31, 2000;
13 (2) the interruption of the supply of medication may
14 result in substantial physical or mental discomfort or
15 undesirable health consequences for the patient; and
16 (3) does not prescribe or authorize a refill more than
17 once for the same medication in accordance with the
18 provisions of this section.
19 Section 3. Insurance carrier.
20 (a) Coverage.--Any coverage for prescription medication
21 provided under any individual or group plan, policy or contract
22 for health care services issued, delivered, issued for delivery
23 or renewed in this Commonwealth by an insurance carrier or
24 similar entity which would otherwise extend to medications
25 prescribed under this act but for a limitation of the number of
26 days' supply of medication covered under such plan, policy or
27 contract shall be deemed to extend to medications prescribed
28 under section 2, notwithstanding the limitation of such plan,
29 policy or contract. If, for purposes of applying any deductibles
30 under such coverage, a new plan year begins at any time during
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1 the period of December 1, 1999, through January 31, 2000, any
2 amount of supply of such prescribed medication which is for use
3 after such new plan year begins shall be applied toward the
4 deductible for such new plan year without regard to the date the
5 prescription was filled or refilled.
6 (b) Liability.--Any insurance carrier or similar entity
7 shall be liable in damages to any person covered under such
8 plan, policy or contract if:
9 (1) The insurance carrier fails to provide coverage for
10 a prescribed medication which otherwise would be covered
11 under its plan, policy or contract but which coverage is
12 denied on the basis of limits imposed by such entity on the
13 supply of medication prescribed or authorized for refilling:
14 (2) The lack of availability of the medication due to
15 denial of coverage at any time during the period beginning
16 January 1, 2000, and ending January 31, 2000, proximately
17 causes loss or injury to such person.
18 Section 4. Effective date.
19 This act shall take effect in 60 days.
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