HARRISBURG – Patients fighting cancer won’t have to worry about their insurance companies blocking their access to the most advanced therapies under legislation signed into law by Gov. Tom Wolf last week.
Under Act 6 of 2020, insurance companies would be barred from forcing doctors treating metastatic cancer patients to try treatments preferred by the insurance company before allowing doctors to try advanced therapies.
Pennsylvania Health Secretary Dr. Rachel Levine said the legislation is an important step to ensure that cancer patients can quickly access whatever treatment doctors believe offers the best hope for recovery.
The legislation specifically aims to help patients with Stage 4 metastatic cancer, cancer that has spread from one part of the body to another.
“For these patients, delay can literally be a matter of life or death,” she said. The new law leaves the important decisions about what treatments are appropriate to the doctors, she said.
Insurers have had the ability to set coverage guidelines that govern how and when treatments are approved, said state Rep. Kerry Benninghoff, R-Centre County, in a memo explaining the legislation. These guidelines sometimes require Stage 4 patients to first try an insurance-mandated series of medicines that fail to improve the condition before the insurer will cover advanced therapies prescribed by their doctor. They are often referred to as “step therapy” or “fail first” policies.
Act 6 is Pennsylvania’s version of legislation first passed in Georgia in 2016 and named after former President Jimmy Carter, Benninghoff said.
Georgia passed its version of the law after Carter announced that he’d successfully been treated after doctors found four small melanoma lesions on his brain, he’d received treatment using the immunotherapy drug, pembrolizumab.
“Those battling late-stage cancer should not have to jump through hoops or be delayed in getting the treatments prescribed by their doctors,” said Benninghoff. “They should have access to the best-proven treatments available.”
There were more than 80,000 people diagnosed with cancer in Pennsylvania in 2016, according to the U.S. Centers for Disease Control and Prevention. In 2017, 28,000 people died due to cancer in Pennsylvania, according to CDC.
Act 6 was introduced in the state House as HB 427. It passed the state House last June and was approved unanimously by the state Senate in January. The Senate made technical amendments, clarifying treatments allowed by the law must be approved by the U.S. Food and Drug Administration. The House voted to approve the Senate changes on Feb. 4, sending the bill to the governor. Wolf signed the bill into law last Wednesday.
The measure had the support of a variety of organizations aimed at fighting cancer, Benninghoff said, including The American Cancer Society/Cancer Action Network, the America Society of Clinical Oncology, Cancer Support Community, Community Oncology Alliance, the National Organization of Rare Disorders, the Pennsylvania Medical Society, Susan G. Komen for the Cure, among other groups.
“When people are faced with a dire diagnosis like stage-4 cancer, their focus should be on fighting the disease and not their health care coverage,” said Dr. Bret Yarczower, senior medical director of health services at Geisinger Health Plan based in Danville, Montour County.
"Geisinger Health Plan recognizes the importance of providing access to life-saving or life-prolonging treatments for people with stage-4 cancer and we partner with our clinical colleagues to make sure our members are afforded access to the most advanced, proven treatments for their disease," he said.