MO SB668

Health benefit plans providing cancer treatment coverage must offer orally administered anticancer medications on the same basis as intravenously administered or injected anticancer medications.

Oral anticancer medications cannot be subject to prior authorization, dollar limits, co-payments, deductibles, or out-of-pocket expenses that differ from intravenous or injected medications regardless of formulation or benefit category.

Health benefit plans cannot reclassify or increase cost-sharing for anticancer medications to achieve compliance, and any coverage changes increasing out-of-pocket costs must apply to the majority of comparable medical or pharmaceutical benefits.

Plans may limit total cost-sharing to $75 per 30-day supply for oral anticancer medications and adjust this limit annually by no more than the Consumer Price Index for All Urban Consumers Midwest Region.

For high deductible health plans, the $75 cap applies only after the covered person's annual deductible is satisfied; effective date is January 1, 2015.