An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for epinephrine delivery systems.

PRINTER'S NO. 1371
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 1126
Session of
2025
INTRODUCED BY COLLETT, TARTAGLIONE, HUGHES, SAVAL, FONTANA,
CAPPELLETTI, HAYWOOD, KEARNEY, COSTA, SANTARSIERO, KANE,
L. WILLIAMS AND MILLER, DECEMBER 29, 2025
REFERRED TO BANKING AND INSURANCE, DECEMBER 29, 2025
AN ACT
Amending the act of May 17, 1921 (P.L.682, No.284), entitled "An
act relating to insurance; amending, revising, and
consolidating the law providing for the incorporation of
insurance companies, and the regulation, supervision, and
protection of home and foreign insurance companies, Lloyds
associations, reciprocal and inter-insurance exchanges, and
fire insurance rating bureaus, and the regulation and
supervision of insurance carried by such companies,
associations, and exchanges, including insurance carried by
the State Workmen's Insurance Fund; providing penalties; and
repealing existing laws," in casualty insurance, providing
for coverage for epinephrine delivery systems.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. The act of May 17, 1921 (P.L.682, No.284), known
as The Insurance Company Law of 1921, is amended by adding a
section to read:
Section 635.11. Coverage for Epinephrine Delivery Systems.--
(a) A health insurance entity licensed in this Commonwealth to
offer, issue or renew any individual or group health, sickness
or accident policy or subscriber contract or certificate that
provides medical or health care coverage by a health care
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facility or licensed health care provider, and a certified
health plan corporation or general medical service corporation
engaged in the business of maintaining and operating a nonprofit
professional health service plan in this Commonwealth, shall
include coverage for, at a minimum, two medically prescribed
epinephrine delivery systems:
(1) prescribed by a health care provider; and
(2) at an amount not to exceed thirty-five dollars ($35)
annually regardless of the insured's deductible, copayment,
coinsurance or any other cost-sharing requirement.
(b) The coverage required under subsection (a) may be
subject to annual deductibles and coinsurance as deemed
appropriate by the Insurance Commissioner.
(c) Nothing in this section shall be construed to prevent a
health care group, general medical service corporation or
hospital service corporation from reducing a covered person's
cost sharing to an amount that is lower than the amount
specified in subsection (a).
(d) The Insurance Department may promulgate regulations as
necessary to implement and enforce the maximum price established
under this section.
(e) The Attorney General shall:
(1) Investigate pricing of prescription epinephrine drugs to
ensure that adequate pricing of prescription epinephrine drugs
is achieved and to determine if additional consumer protections
are necessary. As part of the investigation, the Attorney
General shall gather, complete and analyze information
concerning business practices, pricing, data and other
information regarding epinephrine drug manufacturers' roles in
the current prices of epinephrine prescription drugs.
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(2) Submit the findings of the investigation under this
subsection in a report to the General Assembly, which shall be
made accessible to the public no later than one year after the
effective date of this paragraph. The report shall include:
(i) A summary of epinephrine pricing practices and factors
that contribute to the pricing of health insurance plans.
(ii) Public policy recommendations to control and prevent
overpricing of prescription epinephrine drugs made available to
consumers in this Commonwealth.
(iii) Any other information that the Attorney General finds
necessary to complete the report.
(f) This section shall apply to:
(1) A high deductible health plan to the maximum extent
permitted by Federal law. If the plan is used to establish a
medical savings account under section 220 of the Internal
Revenue Code of 1986 (Public Law 99-514, 26 U.S.C. § 220) or a
health savings account under section 223 of the Internal Revenue
Code of 1986 (Public Law 99-514, 26 U.S.C. § 223), this section
shall apply to the plan to the maximum extent that is permitted
by Federal law and does not disqualify the account for the
deduction allowed under section 220 or 223 of the Internal
Revenue Code of 1986, as applicable.
(2) A plan that meets the requirements of a catastrophic
plan, as defined in 45 CFR 156.155 (relating to enrollment in
catastrophic plans), to the maximum extent permitted by Federal
law.
(g) As used in this section, the following words and phrases
shall have the meanings given to them in this subsection unless
the context clearly indicates otherwise:
"Epinephrine delivery system." A single-use device used for
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the automatic injection of, or a single-dose nasal spray device
used for the delivery of, a premeasured dose of epinephrine into
the human body.
"High deductible health plan." A health insurance policy as
defined in section 223(c)(2) of the Internal Revenue Code of
1986 (Public Law 99-514, 26 U.S.C. § 223(c)(2)), only after the
covered person's deductible has been satisfied for the year.
Section 2. This act shall apply to all policies and
contracts issued, renewed, modified, altered or amended on or
after the effective date of this section.
Section 3. This act shall take effect in 60 days.
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