Florida Senate - 2021 SB 1392
By Senator Harrell
1 A bill to be entitled
2 An act relating to health insurance coverage for
3 cancer treatment; amending s. 627.4239, F.S.; defining
4 the terms “associated condition” and “health care
5 provider”; prohibiting health maintenance
6 organizations from excluding coverage for certain
7 cancer treatment drugs; prohibiting health insurers
8 and health maintenance organizations from requiring,
9 before providing prescription drug coverage for the
10 treatment of stage 4 metastatic cancer and associated
11 conditions, that treatment has failed with a different
12 drug; providing applicability; prohibiting insurers
13 and health maintenance organizations from excluding
14 coverage for certain drugs on certain grounds;
15 prohibiting insurers and health maintenance
16 organizations from requiring that certain cancer
17 treatment drugs be sent to certain entities for home
18 infusion unless a certain condition is met; revising
19 construction; providing an effective date.
21 Be It Enacted by the Legislature of the State of Florida:
23 Section 1. Section 627.4239, Florida Statutes, is amended
24 to read:
25 627.4239 Coverage for use of drugs in treatment of cancer.—
26 (1) DEFINITIONS.—As used in this section, the term:
27 (a) “Associated condition” means a symptom or side effect
29 1. Is associated with a particular cancer at a particular
30 stage or with the treatment of that cancer; and
31 2. In the judgment of a health care provider, will further
32 jeopardize the health of a patient if left untreated. As used in
33 this subparagraph, the term “health care provider” means a
34 physician licensed under chapter 458, chapter 459, or chapter
35 461, a physician assistant licensed under chapter 458 or chapter
36 459, an advanced practice registered nurse licensed under
37 chapter 464, or a dentist licensed under chapter 466.
38 (b) “Medical literature” means scientific studies published
39 in a United States peer-reviewed national professional journal.
(b) “Standard reference compendium” means authoritative
41 compendia identified by the Secretary of the United States
42 Department of Health and Human Services and recognized by the
43 federal Centers for Medicare and Medicaid Services.
44 (2) COVERAGE FOR TREATMENT OF CANCER.—
45 (a) An insurer or a health maintenance organization may not
46 exclude coverage in any individual or group health insurance
47 policy or health maintenance contract issued, amended,
48 delivered, or renewed in this state which covers the treatment
49 of cancer for any drug prescribed for the treatment of cancer on
50 the ground that the drug is not approved by the United States
51 Food and Drug Administration for a particular indication, if
52 that drug is recognized for treatment of that indication in a
53 standard reference compendium or recommended in the medical
55 (b) Coverage for a drug required by this section also
56 includes the medically necessary services associated with the
57 administration of the drug.
58 (3) COVERAGE FOR TREATMENT OF STAGE 4 METASTATIC CANCER AND
59 ASSOCIATED CONDITIONS.—
60 (a) An insurer or a health maintenance organization may not
61 require in any individual or group health insurance policy or
62 health maintenance contract issued, amended, delivered, or
63 renewed in this state which covers the treatment of stage 4
64 metastatic cancer and its associated conditions that, before a
65 drug prescribed for the treatment is covered, the insured or
66 subscriber fail or have previously failed to respond
67 successfully to a different drug.
68 (b) Paragraph (a) applies to a drug that is recognized for
69 the treatment of such stage 4 metastatic cancer or its
70 associated conditions, as applicable, in a standard reference
71 compendium or that is recommended in the medical literature. The
72 insurer or health maintenance organization may not exclude
73 coverage for such drug on the ground that the drug is not
74 approved by the United States Food and Drug Administration for
75 such stage 4 metastatic cancer or its associated conditions, as
77 (4) COVERAGE FOR SERVICES ASSOCIATED WITH DRUG
78 ADMINISTRATION.—Coverage for a drug required by this section
79 also includes the medically necessary services associated with
80 the administration of the drug.
81 (5) PROHIBITION ON MANDATORY HOME INFUSION.—An insurer or a
82 health maintenance organization may not require that a cancer
83 medication be administered using home infusion, and may not
84 require that such medication be sent directly to a third party
85 or to the patient for home infusion unless the patient’s
86 treating oncologist determines that home infusion of the cancer
87 medication will not jeopardize the health of the patient.
88 (6) (3) APPLICABILITY AND SCOPE.—This section may not be
89 construed to:
90 (a) Alter any other law with regard to provisions limiting
91 coverage for drugs that are not approved by the United States
92 Food and Drug Administration, except for drugs for the treatment
93 of stage 4 metastatic cancer or its associated conditions.
94 (b) Require coverage for any drug, except for a drug for
95 the treatment of stage 4 metastatic cancer or its associated
96 conditions, if the United States Food and Drug Administration
97 has determined that the use of the drug is contraindicated.
98 (c) Require coverage for a drug that is not otherwise
99 approved for any indication by the United States Food and Drug
100 Administration, except for a drug for the treatment of stage 4
101 metastatic cancer or its associated conditions.
102 (d) Affect the determination as to whether particular
103 levels, dosages, or usage of a medication associated with bone
104 marrow transplant procedures are covered under an individual or
105 group health insurance policy or health maintenance organization
107 (e) Apply to specified disease or supplemental policies.
108 (f) (4) Nothing in this section is intended, Expressly or by
109 implication, to create, impair, alter, limit, modify, enlarge,
110 abrogate, prohibit, or withdraw any authority to provide
111 reimbursement for drugs used in the treatment of any other
112 disease or condition.
113 Section 2. This act shall take effect January 1, 2022.