New Pennsylvania Bill to Overturn ‘Fail First’ Cancer Treatment Guidelines

A new bill would require health insurance companies to approve prescribed treatments for patients with stage IV metastatic cancer regardless of what insurance typically covers.^1-3

House Bill 427, introduced by Representative Kerry Benninghoff (R-Centre/Mifflin), would keep patients in Pennsylvania from being forced to try cheaper drugs before their insurance covers other, more expensive treatments.^1-3

“Those battling late-stage cancer should not have to jump through hoops to be delayed in getting the treatments prescribed by their doctors,” Benninghoff said in a press release.⁴ “They should have access to the best proven treatments available.”

The bill has been signed by the House after being amended with minor changes, then was unanimously approved by the state Senate. It is expected to be signed into law by Governor Tom Wolf (D) within the next 10 days; it would then go into effect 60 days after the governor’s approval.³

Under current law, insurance companies have the ability to set coverage guidelines that govern how and when treatments are approved. Those guidelines often require stage IV patients to “fail first,” meaning that they must first try an insurance-mandated series of medications that fail to improve the conditions before being granted access to the oncology medication and treatments prescribed by their doctor.²

“Time is everything for those facing stage IV metastatic cancer. We shouldn’t require that very sick cancer patients, who are in the fight of their lives, get sicker and sicker before they are given access to treatment that may help them improve,” Benninghoff said in a press release.⁴

Senate Banking and Insurance Committee Chair, Senator Mario Scavello (R-40), applauded the Pennsylvania Senate’s passage of the act, known as the Fair Access to Cancer Treatment Act.

“Metastatic patients experience an expansion of their cancer to new parts and organs in the body. For these patients, time is of the essence, and delays in treatment are matters of life and death,” Scavello said in a press release.⁵ “I am proud to be a part of moving this important legislation forward and offer help to all those survivors and their families.”

Legislatures in Georgia, Illinois, and Maryland have passed similar legislation in recent years.¹

References

• Fernandez, Cynthia. ‘Fail first’ no more: Pennsylvania moves to expand coverage of treatments for advanced cancers. Philadelphia Inquirer. Published February 6, 2020. https://www.inquirer.com/news/pennsylvania/spl/cancer-insurance-legislation-wolf-20200205.html. Accessed February 12, 2020.
• Fernandez, Cynthia. State House passes bill to abolish 'fail first' approach for stage IV cancer patients. Pittsburgh Gazette. Published February 5, 2020. https://www.post-gazette.com/news/politics-state/2020/02/05/PA-sate-House-passes-bill-to-abolish-fail-first-approach-for-stage-IV-cancer-patients/stories/202002050138. Accessed February 12, 2020.
• New bill to improve stage IV cancer treatment approved by state House and Senate. North Central Pennsylvania website. Published February 8, 2020. https://www.northcentralpa.com/life/new-bill-to-improve-stage-iv-cancer-treatment-approved-by/article_8410000c-48c1-11ea-85e5-2f08b1e83a79.html. Accessed February 12, 2020.
• Benninghoff Bill to Ensure Best Treatment Options for Stage IV Cancer Patients Passes House of Representatives [news release]. Kerry Benninghoff website. Published June 24, 2019. http://www.kerrybenninghoff.com/News/11471/Press-Releases/Benninghoff-Bill-to-Ensure-Best-Treatment-Options-for-Stage-IV-Cancer-Patients-Passes-House-of-Representatives. Accessed February 12, 2020.
• Scavello: Senate Approves Fair Access to Cancer Treatment Act, Improved Breast Cancer Screening Coverage [news release]. Senator Scavello website. Published January 29, 2020. https://www.senatorscavello.com/2020/01/29/scavello-senate-approves-fair-access-to-cancer-treatment-act-improved-breast-cancer-screening-coverage/. Accessed February 12, 2020.