Last Updated: Feb 18, 2020
By Michael D. I. Siget, JD, MPA, PAMED’s Legislative & Regulatory Counsel
With Pennsylvania’s budget season in full force, the legislature will turn much of its focus to enacting a budget for the 2020-2021 fiscal year. However, three health-related bills were signed by Gov. Wolf recently. In this Bills on the Hill, we will look at insurance coverage for Stage IV metastatic cancer, regulation of milk banks, and amendments to the prescription drug monitoring program (PDMP) law.
Coverage for Stage IV Metastatic Cancer
HB 427, introduced by Rep. Kerry Benninghoff, prohibits a health insurance carrier or policy that directly or indirectly covers the treatment of Stage IV advanced metastatic cancer to require an enrollee to first fail to successfully respond to a different drug, or prove a history of failure in the use of a different drug, before providing coverage for a covered drug for which the drug has been approved by the U.S. FDA and the drug is consistent with the best clinical practices for the treatment of Stage IV advanced metastatic cancer and is supported by peer-reviewed medical literature.
HB 427 was signed into law at Act 6-2020 on February 12, 2020 and takes effect on April 12, 2020.
The Keystone Mothers’ Milk Bank Act
HB 1001, introduced by Rep. Donna Oberlander and Rep. Rosita Youngblood, will require the state’s Department of Health to license and regulate milk banks in the Commonwealth. Milk banks requiring licensure shall pay a $1,000 fee for an initial two-year license and a $250 fee for each license renewal. Milk banks in operation prior to the effective date of this act are able to continue to operate pending a decision on their application so long as their application are made within 120 days of the later of the effective date of the act or the date an application for a license is first made available.
Each milk bank will be required to have a managing director, a medical advisory committee, a medical director, and a board of directors. Milk banks also will be required to maintain records on each milk donor, along with results of laboratory tests performed on donors and milk, and information tracing each donated milk contained from donor to distribution.
Subject to specific exceptions, donors must voluntarily contribute milk to a milk bank after being medically screened and approved for milk donation and they may not receive remuneration for the donation of milk. To receive an exception, a milk bank must meet or exceed additional standards required by the Department of Health that are reasonably necessary to protect public health and the recipient of the donor milk, the donor, and the donor’s baby.
HB 1001 was signed into law on February 12, 2020 as Act 7-2020. Some parts took effect immediately and the remainder of the bill will take effect on August 10, 2020.
Amendments to the PDMP Law
SB 432, introduced by Sen. Kristin Phillips-Hill, amends the Achieving Better Care by Monitoring All Prescriptions Program (ABC-MAP) Act, better known as the PDMP Law. SB 432 grants certain individuals of Medicaid Managed Care Organizations to have access to the information contained in the PDMP program.
The main issue that this bill hopes to address is to better identify potential prescription drug abuse among individuals enrolled in the state’s Medicaid program. SB 432 also grants access to authorized employees of a municipal health department of the state’s Department of Health to develop educational programs or public health interventions relating to specific prescribing practices, controlled substances, and the prevention of fraud and abuse.
An amendment was added to SB 432 that prohibits any political subdivision of the Commonwealth from establishing its own PDMP database that would require the submission and query of prescription data by prescribers and dispensers. Philadelphia City Council had recently passed an ordinance requiring pharmacies to send reports to the city’s health department for all controlled substance prescriptions. These reports require the name of the prescribing doctor, the type of drug, how much is being prescribed, and how often.
SB 432 was signed into law on February 12, 2020 as Act 8-2020. The political subdivision prohibition section took effect immediately. The remainder of the law takes effect on April 12, 2020.