Bill Text: MI SB0492 | 2017-2018 | 99th Legislature | Engrossed

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Bill Title: Insurance; health insurers; coverage for orally administered anticancer medication; provide equal treatment for. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406u.

Spectrum: Partisan Bill (Republican 1-0)

Status: (Engrossed - Dead) 2018-06-07 - Recommendation Concurred In [SB0492 Detail]

Download: Michigan-2017-SB0492-Engrossed.html

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SB-0492, As Passed Senate, October 18, 2017

 

 

 

 

 

 

 

 

 

 

SUBSTITUTE FOR

 

SENATE BILL NO. 492

 

 

 

 

 

 

 

 

 

 

 

 

     A bill to amend 1956 PA 218, entitled

 

"The insurance code of 1956,"

 

(MCL 500.100 to 500.8302) by adding section 3406u.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 3406u. (1) A health insurance policy delivered, issued

 

for delivery, or renewed in this state that provides coverage for

 

prescribed orally administered anticancer medications and

 

intravenously administered or injected anticancer medications must

 

ensure both of the following:

 

     (a) That the health insurance policy ensures either of the

 

following:

 

     (i) That financial requirements applicable to prescribed

 

orally administered anticancer medications are no more restrictive

 

than the financial requirements applied to intravenously

 

administered or injected anticancer medications that are covered by

 

the health insurance policy and that there are no separate cost-

 

sharing requirements that are applicable only to prescribed orally

 

administered anticancer medications.

 

     (ii) That the financial requirement for orally administered

 

anticancer medication does not exceed $100.00 per 30-day supply.

 

Beginning January 1, 2019, and each January 1 thereafter, the

 

department shall adjust the financial requirement described in this

 

subparagraph by an amount determined by the state treasurer that

 

reflects the cumulative annual change in the prescription drug

 

index of the medical care component of the United States consumer

 

price index.

 

     (b) That treatment limitations applicable to prescribed orally

 

administered anticancer medications are no more restrictive than

 

the treatment limitations applied to intravenously administered or

 

injected anticancer medications that are covered by the health

 

insurance policy and that there are no separate treatment

 

limitations that are applicable only to prescribed orally

 

administered anticancer medications.

 

     (2) Beginning with the effective date of the amendatory act

 

that added this section, an insurer cannot achieve compliance with

 

this section by doing any of the following:

 

     (a) Increasing financial requirements.

 

     (b) Reclassifying benefits with respect to anticancer

 

medications.

 

     (c) Imposing more restrictive treatment limitations on

 

prescribed orally administered anticancer medications or

intravenously administered or injected anticancer medications

 

covered under the policy, certificate, or contract.

 

     (3) For a health insurance policy that is a high-deductible

 

plan as that term is defined in 26 USC 223(c)(2), the requirements

 

under subsection (1)(a) apply only after the minimum annual

 

deductible specified in 26 USC 223(c)(2) is reached.

 

     (4) This section does not prohibit an insurer from applying

 

utilization management techniques, including prior authorization,

 

step therapy, limits on quantity dispensed, and days' supply per

 

fill for any administered anticancer medication.

 

     (5) This section does not apply to a health insurance policy

 

that provides coverage for specific diseases or accidents only, or

 

to a hospital indemnity, Medicare supplement, long-term care,

 

disability income, or 1-time limited duration policy or certificate

 

that has a term of 6 months or less.

 

     (6) Except as otherwise provided in subsection (2), this

 

section applies to health insurance policies delivered, executed,

 

issued, amended, adjusted, or renewed in this state, or outside of

 

this state if covering residents of this state, after December 31,

 

2018.

 

     (7) As used in this section:

 

     (a) "Anticancer medication" means a medication used to kill,

 

slow, or prevent the growth of cancerous cells.

 

     (b) "Financial requirement" means deductibles, copayments,

 

coinsurance, out-of-pocket expenses, aggregate lifetime limits, and

 

annual limits.

 

     (c) "Treatment limitation" means limits on the frequency of

treatment, days of coverage, or other similar limits on the scope

 

or duration of treatment. Treatment limitation does not include the

 

application of utilization management techniques described in

 

subsection (4).