HB 2427 — Summary
Overview
- Jurisdiction: Pennsylvania
- Session: 2025-2026
- Title: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921
- Primary aim: Update quality health care accountability and protection provisions and add utilization management requirements for stage four, advanced metastatic cancer drugs; includes a repeal of a prior provision as part of the amendments.
- Sponsors: Ed Neilson; Kerry Benninghoff; Greg Vitali; Tina Pickett; Ben Sanchez; Carol Hill-Evans; Perry Warren; Arvind Venkat (co-sponsors listed)
Purpose and intent
- Strengthen oversight of health care quality and patient protections within Pennsylvania’s Insurance Company Law framework.
- Establish or refine utilization management rules specifically for high-cost, late-stage cancer therapies (stage four, advanced metastatic cancer drugs).
- Align state law with goals of improving treatment transparency, ensuring appropriate use of expensive oncology medications, and protecting patients from overuse or inappropriate denial of benefits.
Key provisions and changes (substantive provisions)
- Quality health care accountability: The act broadens or clarifies definitions related to quality care and patient protections under the Insurance Company Law of 1921. This may include standards for plan benefit design, provider performance, and consumer protections in coverage decisions.
- Utilization management for stage four cancers: The bill adds or specifies utilization management criteria for stage four, advanced metastatic cancer drugs. Provisions may address:
- Prior authorization requirements for certain high-cost oncology therapies.
- Medical necessity criteria and documentation standards.
- Timelines for decision making and appeal rights related to oncology drug coverage.
- Standards to prevent inappropriate drug denial or delay of treatment.
- Repeal: The act repeals a prior provision (not specified in the summary) as part of the modernization or consolidation of quality accountability and utilization management rules. The repeal likely aligns with updated definitions or processes proposed in the bill.
- Administrative and enforcement elements: The bill may create or enhance enforcement mechanisms, complaint processes, and potential penalties or corrective actions for insurers that fail to comply with the new utilization management or quality standards.
- Effective dates: The bill would establish effective dates for new provisions, including any phased-in timelines for insurers to implement utilization management criteria and reporting requirements. (Exact dates would be in the text.)
Who is affected
- Health insurers and their administrative operations in Pennsylvania, including:
- Application of utilization management criteria for late-stage cancer drugs.
- Compliance with updated quality-of-care definitions and reporting requirements.
- Patients with cancer and high-cost oncology treatments, whose access decisions, prior authorizations, and coverage determinations may be affected by new utilization management standards.
- Health care providers and oncologists who may need to provide additional documentation to justify medical necessity for advanced metastatic cancer therapies.
- State regulators and the Pennsylvania Department of Insurance, which would administer, monitor, and enforce the new provisions.
Procedural and timeline considerations
- The bill would proceed through the standard Pennsylvania legislative process (committee reviews, debates, amendments, and votes in both chambers).
- Once enacted, there would be specified effective dates for different sections, potentially including:
- Immediate applicability for certain provisions.
- A phased implementation period for utilization management criteria and reporting systems.
- Repealed provisions would cease to have effect on the effective repeal date.
Notes for readers
- The summary reflects the bill’s stated changes to quality health care accountability and utilization management for late-stage cancer drugs, within the framework of The Insurance Company Law of 1921.
- For precise language, definitions, and all timelines, consult the bill text as filed and any fiscal notes or impact statements associated with HB 2427.
