MI SB0492

Health insurance policies covering anticancer medications must ensure financial requirements for orally administered drugs are no more restrictive than intravenously administered or injected drugs, with no separate cost-sharing requirements for oral medications.

Financial requirements for orally administered anticancer medications cannot exceed $100.00 per 30-day supply, with annual adjustments beginning January 1, 2019, based on the prescription drug index of the medical care component of the U.S. consumer price index.

Treatment limitations applicable to orally administered anticancer medications must be no more restrictive than those applied to intravenously administered or injected medications, with no separate treatment limitations for oral drugs only.

Insurers cannot achieve compliance by increasing financial requirements, reclassifying benefits, or imposing more restrictive treatment limitations on any anticancer medications.

Applies to health insurance policies delivered, issued, or renewed in Michigan after December 31, 2018, and permits insurers to use utilization management techniques including prior authorization and step therapy.