An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in quality health care accountability and protection, further providing for definitions and for step therapy considerations.

PRINTER'S NO. 1876
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 1409
Session of
2026
INTRODUCED BY PENNYCUICK, BOSCOLA, PHILLIPS-HILL, BARTOLOTTA,
BROWN, ARGALL, BROOKS, VOGEL, J. WARD, KEARNEY, SAVAL AND
CULVER, JULY 9, 2026
REFERRED TO BANKING AND INSURANCE, JULY 9, 2026
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 quality health care
accountability and protection, further providing for
definitions and for step therapy considerations.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 2102 of the act of May 17, 1921 (P.L.682,
No.284), known as The Insurance Company Law of 1921, is amended
by adding definitions to read:
Section 2102. Definitions.--As used in this article, the
following words and phrases shall have the meanings given to
them in this section:
* * *
"Behavioral health crisis." A significant disruption in a
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person's mental or emotional stability or functioning resulting
in an urgent need for immediate assessment and treatment to
prevent a serious deterioration in the person's mental or
physical health.
* * *
"Serious mental illness." A mental illness, disorder or
condition included in the following classes of mental disorders
designated in the American Psychiatric Association's Diagnostic
and Statistical Manual of Mental Disorders, Fifth Edition, Text
Revision, 2022:
(1) Schizophrenia spectrum and other psychotic disorders.
(2) Bipolar and related disorders.
(3) Depressive disorders.
(4) Anxiety disorders.
(5) Obsessive-compulsive and related disorders.
(6) Feeding and eating disorders.
* * *
Section 2. Section 2156(b) of the act is amended and the
section is amended by adding a subsection to read:
Section 2156. Step therapy considerations.
* * *
(a.1) Step therapy and prior authorization exemption for
serious mental illness.--
(1) If an insurer or MA or CHIP managed care plan
requires prior authorization or step therapy for a
prescription drug prescribed in response to a serious mental
illness, the insurer or MA or CHIP managed care plan may only
require a covered person or enrollee to try one prescription
drug other than the drug prescribed by the provider prior to
providing authorization to the covered person or enrollee for
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the prescription drug prescribed by the provider.
(2) A health insurer or MA or CHIP managed care plan may
not require prior authorization or step therapy for a
prescription drug if the prescription drug is:
(i) approved by the United States Food and Drug
Administration;
(ii) used for treatment in response to a behavioral
health crisis; and
(iii) prescribed consistent with evidence-based
standards and medical or scientific evidence.
(b) Applicability.--[The] Unless otherwise specified in this
section, the standards and time lines specified in section 2155
shall apply to a review of a request for a step therapy
exception.
Section 3. This act shall apply as follows:
(1) For a health insurance policy for which either rates
or forms are required to be filed with the Insurance
Department, this act shall apply to a policy for which a form
or rate is first filed on or after the effective date of this
paragraph.
(2) For a health insurance policy for which neither
rates nor forms are required to be filed with the Insurance
Department, this act shall apply to a policy issued or
renewed on or after 180 days after the effective date of this
paragraph.
Section 4. This act shall take effect January 1, 2027.
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