Bill Text: MI SB0492 | 2017-2018 | 99th Legislature | Introduced
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-Introduced.html
SENATE BILL No. 492
June 22, 2017, Introduced by Senators HANSEN, GREEN, BOOHER, KNOLLENBERG, BIEDA, WARREN, SCHMIDT, PROOS, JONES, MARLEAU, HILDENBRAND, CASPERSON, YOUNG, HERTEL, JOHNSON and COLBECK and referred to the Committee on Insurance.
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) If all of the following apply, an insurer is not required
to comply with subsection (1) beginning the next benefit year after
the date on which all of the following apply:
(a) The insurer submits to the department a written request
that the department conduct a study measuring the impact of
implementing subsection (1). In conducting the study, the
department shall consider both of the following:
(i) The insurer's costs for claims and administrative expenses
to determine if for a period of at least 6 months compliance with
subsection (1) will independently cause the insurer's costs for
claims and administrative expenses for all covered benefits to
increase by more than 1% per year.
(ii) If the increase in costs described in subparagraph (i)
reasonably justifies an increase of more than 1% in the annual
premiums or rates charged by the insurer.
(b) Subject to subsection (7), the department determines both
of the following from the study conducted under subdivision (a):
(i) Compliance with subsection (1) for a period of at least 6
months will independently cause the insurer's costs for claims and
administrative expenses for all covered benefits to increase more
than 1% per year.
(ii) The increase in costs described in subparagraph (i)
reasonably justifies an increase of more than 1% in the annual
premiums or rates charged by the insurer.
(7) The department may request information from the insurer
needed to complete the study under subsection (6). The insurer
shall provide the information to the department within 14 days
after the department's request under this subsection.
(8) The department shall make the determination under
subsection (6)(b) within 90 days after receiving the insurer's
written request submitted under subsection (6)(a).
(9) 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.
(10) 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).
