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SB-0625, As Passed Senate, May 10, 2016

SUBSTITUTE FOR

SENATE BILL NO. 625

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) An expense-incurred hospital, medical, or

surgical policy or certificate delivered, issued for delivery, or

renewed in this state and a health maintenance organization group

or individual contract 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 policy, certificate, or contract 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

Senate Bill No. 625 as amended May 10, 2016

injected anticancer medications that are covered by the policy,

certificate, or contract 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, 2018, and each January 1 thereafter, the

department shall adjust the financial requirement described in this

subparagraph by an amount determined by the <<department>> 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 policy,

certificate, or contract 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 or health maintenance

organization cannot achieve compliance with this section by doing

any of the following:

(a) Increasing financial requirements.

(b) Reclassifying benefits with respect to anticancer

medications.

prescribed orally administered anticancer medications or

intravenously administered or injected anticancer medications

covered under the policy, certificate, or contract.

(3) For a policy, certificate, or contract 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 or health

maintenance organization 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 policy, certificate, or

contract 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 policies, certificates, and contracts delivered,

executed, issued, amended, adjusted, or renewed in this state, or

outside of this state if covering residents of this state, after

December 31, 2016.

(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