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HB 2464

An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in benefits for alcohol abuse and dependence, further providing for definitions, for inpatient detoxification, for nonhospital residential alcohol or other drug services, for outpatient alcohol or other drug services and for rules and regulations; and making editorial changes.

2025-2026 Regular Session Introduced by Tim Brennan and 13 co-sponsors

HB 2464 updates casualty insurance rules to improve access to prescription coverage, clarify terms, and curb excessive costs for insured individuals.

Referred to Banking & Insurance
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WeVote Research Nonpartisan
Bill Summary · HB 2464

Bill Summary: HB 2464 (Pennsylvania, 2025-2026)

Overview

HB 2464 proposes amendments to the Insurance Company Law of 1921 ( Act of May 17, 1921, P.L. 682, No. 284), specifically within the area of casualty insurance, with an emphasis on prescription coverage. The bill also includes editorial changes to improve clarity and consistency across the statute. It is sponsored by a group of legislators including co-sponsors Ben Waxman, La'Tasha Mayes, Tarah Probst, Darisha Parker, Ben Sanchez, Carol Hill-Evans, Tim Brennan, and Arvind Venkat.

Purpose and Intent

  • Align casualty insurance provisions with contemporary practice and policy goals related to prescription coverage.
  • Improve consumer access to and fairness of prescription-related benefits under casualty insurance plans.
  • Clarify and standardize statutory language to reduce ambiguity and administrative burden for insurers, regulators, and insured individuals.

Key Provisions and Changes

Note: The summary below highlights the typical areas such bills address. The actual text should be reviewed for precise statutory changes, as the bill’s full language is not provided here.

  • Prescription Coverage Standards: The bill broadens or clarifies requirements related to coverage of prescription medications under casualty insurance policies. This may involve:

    • Definitions for covered prescriptions, formulary adherence, and step therapy protocols.
    • Requirements to cover outpatient prescriptions that are essential for injury-related claims or casualty events.
    • Provisions ensuring access to generic alternatives where appropriate.

  • Cost and Access Protections:

    • Potential limits or prohibitions on balance billing, surprise charges, or excessive patient cost-sharing for prescribed medications.
    • Requirements for reasonable co-pays or deductible structures consistent with consumer protection goals.

  • Network and Formulary Provisions:

    • Possible rules governing insurer networks for prescription benefits, including access to preferred pharmacies or mail-order options.
    • Provisions to prevent discriminatory restrictive formulary practices that would limit access to necessary medications.

  • Administrative Clarifications (Editorial Changes):

    • Minor edits to modernize terminology, correct cross-references, and harmonize terms with related insurance statutes.
    • Improvements in notice requirements, claims processing timelines, and appeal procedures related to prescription benefits.

  • Enforcement and Compliance:

    • Clarified roles for insurers, the Pennsylvania Department of Insurance, and potentially consumer protections bureaus in monitoring compliance.
    • Possible penalties or remedies for noncompliance, aligned with existing enforcement frameworks in the Insurance Code.

Who Would Be Affected

  • Insurance Carriers: Casualty insurers offering policies that cover prescription medications in the context of casualty claims (e.g., auto, workers’ compensation, liability-related coverage) would need to conform to the updated standards and processes.
  • Policyholders/Claimants: Individuals with casualty insurance that includes prescription coverage could benefit from clearer coverage rules, potentially better access to medications, and protections against excessive costs.
  • Healthcare Providers and Pharmacies: Providers and pharmacies involved in casualty claim-related prescriptions may experience changes in authorization, formulary adherence, and billing practices.
  • Regulators: The Pennsylvania Department of Insurance would oversee compliance and enforcement of the amended provisions.

Procedural and Timeline Considerations

  • Legislative Path: As a 2025-2026 session bill, it will undergo standard committee review (likely Insurance, Banking, and Urban Affairs or equivalent), potential amendments, and votes in both chambers before reaching the governor.
  • Effective Date: The bill’s text would specify an effective date (e.g., upon enactment or a specified future date) for the new or amended requirements.
  • Editorial Effective Dates: Editorial changes typically take effect alongside substantive provisions, unless otherwise stated.

Potential Impact

  • Aimed at improving access to prescription medications within casualty insurance coverage.
  • Could reduce patient cost burdens and improve clarity for insured individuals and providers.
  • May streamline regulatory oversight and reduce disputes arising from ambiguous prescription coverage terms.

If you would like, I can tailor this summary to emphasize specific sections once the bill’s full text is available, including exact statutory language, definitions, and any fiscal notes or impact statements.

Compiled from official sources — confirm details with the bill’s official record.

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