Pennsylvania SB 1215: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in health insurance coverage parity and nondiscrimination, further providing for nondiscrimination of chiropractic services and imposing penalties.

Bill Text

PRINTER'S NO. 1502
THE GENERAL ASSEMBLY OF PENNSYLVANIA
SENATE BILL
No. 1215
Session of
2026
INTRODUCED BY ROBINSON, BARTOLOTTA, VOGEL, ARGALL, HUTCHINSON,
PHILLIPS-HILL, BOSCOLA AND STEFANO, MARCH 13, 2026
REFERRED TO LABOR AND INDUSTRY, MARCH 13, 2026
AN ACT
Amending the act of June 2, 1915 (P.L.736, No.338), entitled "An
act defining the liability of an employer to pay damages for
injuries received by an employe in the course of employment;
establishing an elective schedule of compensation; providing
procedure for the determination of liability and compensation
thereunder; and prescribing penalties," in liability and
compensation, further providing for schedule of compensation.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 306(f.1)(3)(vi) of the act of June 2,
1915 (P.L.736, No.338), known as the Workers' Compensation Act,
is amended by adding subclauses to read:
Section 306. The following schedule of compensation is
hereby established:
* * *
(f.1) * * *
(3) * * *
(vi) * * *
(G.1) The reimbursement for any compound drug shall be
calculated on a per ingredient basis as determined in accordance
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with subclause (A). If any individual ingredient does not have a
valid and recognized NDC number, the compound drug shall not be
reimbursed. The following shall apply:
(I) A retail pharmacy, mail order pharmacy or physician
shall be reimbursed a single compounding fee of twenty dollars
($20) per prescription filled and dispensed.
(II) In no instance shall reimbursement for a compound drug
exceed four hundred dollars ($400) per thirty-day supply or a
prorated amount if the supply is greater or less than thirty
days.
(III) A compound drug that is essentially a duplicate of a
commercially available drug product is not reimbursable. The
status of a compound drug as essentially a duplicate of a
commercially available drug product shall be determined pursuant
to 21 U.S.C. § 353b (relating to outsourcing facilities).
(G.2) The reimbursement for any noncompound topical drug
shall be the lesser of one hundred and ten per centum of the
AWP, the Federal Upper Limit as established by the Centers for
Medicare and Medicaid Services pursuant to 42 U.S.C. § 1396r-
8(e)(4) (relating to payment for covered outpatient drugs) and
42 CFR 447.514 (relating to upper limits for multiple source
drugs) or two hundred forty dollars ($240) for a thirty-day
supply, prorated if the supply is greater or less than thirty
days, plus a single dispensing fee of ten dollars ($10) per
prescription.
* * *
(J) As used in this subclause:
"Compound drug" shall mean a non-Food and Drug Administration
approved pharmaceutical preparation that is prescribed by a
physician and prepared by a licensed pharmacist or physician by
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combining, mixing or altering ingredients to tailor a medication
to the needs of an individual employe, including when a
commercially available Food and Drug Administration-approved
drug is not suitable to meet those needs. The term includes, but
is not limited to, dermatological agents or topical preparations
such as creams, gels, ointments and transdermal patches
formulated using bulk ingredients or commercially available
products that are combined or altered outside of Food and Drug
Administration-approved labeling.
"Topical drug" shall mean a drug or medication applied to the
skin with intention to provide a localized or systemic result.
The term shall include creams, gels, ointments and transdermal
patches.
* * *
Section 2. This act shall take effect in 60 days.
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