Bill Text: DE HB364 | 2023-2024 | 152nd General Assembly | Draft

Delaware House Bill 364

Draft

Bill Title: An Act To Amend Title 18 Of The Delaware Code Relating To Cancer Coverage.

Spectrum: Strong Partisan Bill (Democrat 10-1)

Status: (Introduced) 2024-04-16 - Reported Out of Committee (Economic Development/Banking/Insurance & Commerce) in House with 5 Favorable, 4 On Its Merits [HB364 Detail]

Download: Delaware-2023-HB364-Draft.html

SPONSOR:	Rep. Romer & Sen. Poore
Reps. Dukes, Heffernan, Morrison; Sens. Hoffner, Sokola

HOUSE OF REPRESENTATIVES

152nd GENERAL ASSEMBLY

HOUSE BILL NO. 364

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO CANCER COVERAGE.

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

Section 1. Amend § 3338B, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

§ 3338B. Coverage of drugs approved for treatment of certain cancers [For application of this section, see 81 Del. Laws, c. 180, §§ 3 and 4].

(a) No individual policy or contract of health insurance, or certificate issued thereunder, which is delivered, issued for delivery, renewed, modified, altered, or amended in this State by any health insurer, health service corporation or health maintenance organization that directly or indirectly covers the treatment of cancer shall limit or exclude coverage for a drug approved by the United States Food and Drug Administration by mandating that the insured shall first be required to fail to successfully respond to a different drug or drugs or prove a history of failure of such a different drug or drugs; provided, however that the use of such drug or drugs is consistent with best practices for the treatment of stage 4 advanced, metastatic cancer or, in the case of other cancers, the use of the drug is supported by national clinical guidelines, national standards of care, or peer reviewed medical literature for the treatment of the cancer, or in the case of targeted therapy, the target at issue.

(b) No individual policy or contract of health insurance, or certificate issued thereunder, which is delivered, issued for delivery, renewed, modified, altered, or amended in this State by any health insurer, health service corporation, or health maintenance organization that directly or indirectly cover the associated conditions of metastatic cancer shall limit or exclude coverage for drugs approved by the United States Food and Drug Administration by mandating that the insured shall first be required to fail to successfully respond to a different drug or drugs or prove a history of failure of a different drug or drugs; provided, however that the use of such drug is consistent with best practices for the treatment of the associated conditions of metastatic cancer and is supported by national clinical guidelines, national standards of care, or peer reviewed medical literature.

(c) For purposes of this section, “associated conditions” mean the symptoms or side effects associated with metastatic cancer or its treatment and which, in the judgment of the health care practitioner, further jeopardizes the health of a patient if left untreated.

Section 2. Amend § 3555B, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

§ 3555B. Coverage of drugs approved for treatment of certain cancers [For application of this section, see 81 Del. Laws, c. 180, §§ 3 and 4].

(a) No group or blanket policy or contract of health insurance, or certificate issued thereunder thereunder, which is delivered, issued for delivery, renewed, modified, altered, or amended in this State that directly or indirectly covers the treatment of cancer shall limit or exclude coverage for a drug approved by the United States Food and Drug Administration by mandating that the insured shall first be required to fail to successfully respond to a different drug or drugs or prove a history of failure of such a different drug or drugs; provided, however that the use of such drug or drugs is consistent with best practices for the treatment of stage 4 advanced, metastatic cancer or in the case of other cancers, the use of the drug is supported by national clinical guidelines, national standards of care, or for the treatment of the cancer, or in the case of targeted therapy, the target at issue.

(b) No group or blanket policy or contract of health insurance, or certificate issued thereunder, which is delivered, issued for delivery, renewed, modified, altered, or amended in this State that directly or indirectly cover the associated conditions of metastatic cancer shall limit or exclude coverage for drugs approved by the United States Food and Drug Administration by mandating that the insured shall first be required to fail to successfully respond to a different drug or drugs or prove a history of failure of a different drug or drugs; provided, however that the use of such drug is consistent with best practices for the treatment of the associated conditions of metastatic cancer and is supported by national clinical guidelines, national standards of care, or peer reviewed medical literature.

Section 3. This Act applies to all policies, contracts, or certificates, issued, renewed, modified, altered, amended, or reissued after December 31, 2025.

SYNOPSIS

This Act requires that individual, blanket, and group health insurance carriers cover drug treatment for the associated conditions of metastatic cancer in the same way treatment for metastatic cancer is covered. Specifically, it requires insurance companies to cover any FDA approved drug prescribed to treat the side effects of metastatic cancer treatment and prohibits insurance companies from mandating that patients first fail to respond to a different drug or prove a history of failure of such drug. Technical changes are also made to comply with the Delaware Legislative Drafting Manual.