S.B. 493 Summary

• Prohibits health insurers from requiring insured individuals diagnosed with stage two cancer to undergo step therapy before covering drugs prescribed by their health care provider, effective after December 31, 2019.

• Step therapy exemption applies only when the prescribed drug is either an investigational new drug or an FDA-approved prescription drug that is consistent with best practices for stage two cancer treatment and listed on the insurer's formulary.

• Applies the step therapy prohibition to individual and group accident and health policies, hospital and medical service plans, and health maintenance organizations in Hawaii.

• Requires the state auditor to review and report whether an impact assessment is warranted, whether federal ACA requirements are triggered, and whether the prohibition conflicts with medical necessity provisions.

• Effective date of July 1, 2050.