May 21, 2013, Introduced by Rep. Haines and referred to the Committee on Health Policy.
A bill to amend 1956 PA 218, entitled
"The insurance code of 1956,"
(MCL 500.100 to 500.8302) by adding section 3406t.
THE PEOPLE OF THE STATE OF MICHIGAN ENACT:
Sec. 3406t. (1) An insurer that issues, issues for delivery,
or renews in this state an expense-incurred hospital, medical, or
surgical policy or certificate and a health maintenance
organization that issues or renews a group or individual contract
that provides coverage for prescribed orally administered cancer
medications and intravenously administered or injected cancer
medications shall provide for 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 policy,
certificate, or contract 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 policy,
certificate, or contract and that there are no separate treatment
limitations that are applicable only to prescribed orally
administered cancer medications.
(2) An insurer or health maintenance organization 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
policy, certificate, or contract on the effective date of the
amendatory act that added this section.
(3) This section does not prohibit an insurer or health
maintenance organization from increasing cost-sharing for all
benefits.
(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 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 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, beginning 180 days after the date
this amendatory act is enacted into law.