PA 17-228—HB 7023

Insurance and Real Estate Committee

AN ACT CONCERNING STEP THERAPY FOR PRESCRIPTION DRUGS PRESCRIBED TO TREAT STAGE IV METASTATIC CANCER

SUMMARY: This act prohibits individual and group health insurance policies from requiring the use of step therapy for cancer drugs prescribed to treat covered individuals diagnosed with stage IV metastatic cancer, provided the drugs are in compliance with approved federal Food and Drug Administration indications. (Step therapy establishes a sequence for prescribing drugs for specific medical conditions that generally requires patients to try less expensive drugs before higher cost drugs.)

The act also allows a health care provider treating a covered individual with stage IV metastatic cancer to deem step therapy clinically ineffective. However, this appears to have no legal effect because the act prohibits insurance policies from requiring step therapy in such cases.

The act applies to individual and group health insurance policies delivered, issued, renewed, amended, or continued by an insurer, hospital service corporation, medical service corporation, health care center (i.e., HMO), or other entity that provides coverage for prescription drugs.

EFFECTIVE DATE: January 1, 2018