SB-0540, As Passed Senate, December 14, 2011

SUBSTITUTE FOR

SENATE BILL NO. 540

     A bill to amend 1956 PA 218, entitled

"The insurance code of 1956,"

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

THE PEOPLE OF THE STATE OF MICHIGAN ENACT:

Sec. 3406s. (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 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 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 takes effect 6 months

after the date it is enacted into law.