SB-0541, As Passed Senate, December 14, 2011

 

 

 

 

 

 

 

 

 

 

 

SUBSTITUTE FOR

 

SENATE BILL NO. 541

 

 

 

 

 

 

 

 

 

 

 

 

     A bill to amend 1980 PA 350, entitled

 

"The nonprofit health care corporation reform act,"

 

(MCL 550.1101 to 550.1704) by adding section 416e.

 

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

 

     Sec. 416e. (1) A health care corporation group or nongroup

 

certificate that provides coverage for prescribed, orally

 

administered cancer medications and intravenously administered or

 

injected cancer medications shall ensure both of the following:

 

     (a) That financial requirements applicable to prescribed

 

orally administered cancer medications are no more restrictive than

 

the financial requirements applied to intravenously administered or

 

injected cancer medications that are covered by the certificate and

 

that there are no separate cost-sharing requirements that are

 

applicable only to prescribed orally administered cancer

 

medications.

 

     (b) That treatment limitations applicable to prescribed orally

 

administered cancer medications are no more restrictive than the

 

treatment limitations applied to intravenously administered or

 

injected cancer medications that are covered by the certificate and

 

that there are no separate treatment limitations that are

 

applicable only to prescribed orally administered cancer

 

medications.

 

     (2) A health care corporation cannot achieve compliance with

 

this section by increasing financial requirements or imposing more

 

restrictive treatment limitations on prescribed orally administered

 

cancer medications or intravenously administered or injected cancer

 

medications covered under the certificate on the effective date of

 

the amendatory act that added this section.

 

     (3) This section does not prohibit a health care corporation

 

from increasing cost-sharing for all benefits.

 

     (4) This section does not prohibit a health care corporation

 

from applying utilization management techniques, including prior

 

authorization, step therapy, limits on quantity dispensed, and

 

days' supply per fill for an orally administered cancer medication.

 

     (5) As used in this section:

 

     (a) "Cancer medication" means a medication used to kill or

 

slow 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.

 

     Enacting section 1. This amendatory act takes effect 6 months

 

after the date it is enacted into law.