1Amend Bill, page 1, line 11, by inserting after "laws,""

2 in casualty insurance, providing for pharmaceutical coverage
3for oral anticancer medications; and

4Amend Bill, page 1, lines 15 through 17, by striking out all
5of said lines and inserting

6Section 1. The act of May 17, 1921 (P.L.682, No.284), known
7as The Insurance Company Law of 1921, is amended by adding a
8section and an article to read:

9Section 631.1. Pharmaceutical Coverage for Oral Anticancer
10Medications.--(a) Whenever an individual or group health,
11sickness or accident insurance policy or subscriber contract or
12certificate issued by any entity subject to the act of December 
1329, 1972 (P.L.1701, No.364), known as the "Health Maintenance 
14Organization Act," 40 Pa.C.S. Ch. 61 (relating to hospital plan
15corporations) or 63 (relating to professional health services
16plan corporations) or this act provides pharmaceutical coverage
17that includes coverage for cancer chemotherapy or anticancer
18medications which have been approved by the United States Food
19and Drug Administration for general use in the treatment of
20cancer, the policy shall not place orally administered
21anticancer medications on a specialty tier or charge a
22coinsurance payment for orally administered anticancer
23medications. The prohibition of coinsurance payments applies to
24charging a percentage of the cost of the medication or a flat-
25fee cost that is specific to anticancer medication, but does not
26include charging the minimal copayment that is usual for covered
27prescription medications not on a specialty tier.

28(b) Nothing in this section shall serve to diminish the
29benefits of any insured or subscriber in effect on the effective
30date of this section, nor prevent the offering or acceptance of
31benefits which exceed the minimum benefits required by this
32section.

33(c) This section shall apply to those insurance policies,
34subscriber contracts or certificates issued or entered into or
35renewed on or after the effective date of this section.

36(d) As used in this section:

37"Anticancer medication" means a drug or biological product

1that is used to kill, slow or prevent the growth of cancerous
2cells.

3"Specialty tier" means a formulary category for a
4prescription drug that meets one or more of the following
5criteria:

6(1) A high-cost medication that is used to treat and is
7prescribed for a person with a complex, chronic or rare medical
8condition.

9(2) The drug is not typically available at community retail
10pharmacies.

11(3) The drug requires special handling, storage or has
12distribution or inventory limitations.

13(4) The drug has a complex dosing regimen or requires
14special administration.

15(5) The drug is considered to have limited distribution by
16the United States Food and Drug Administration.

17(6) The drug requires complex and extended patient education
18or counseling, intensive monitoring or clinical oversight.

19(7) The drug has significant side effects or risk profile.

20Amend Bill, page 19, line 4, by striking out all of said line
21and inserting

22Section 2. This act shall take effect as follows:

23(1) The following shall take effect immediately:

24(i) This section.

25(ii) The addition of section 631.1 of the act.

26(2) The remainder of this act shall take effect in 60
27days.