7 LONG TITLE
8 General Description:
9 This bill amends provisions relating to health insurance coverage for cancer treatment.
10 Highlighted Provisions:
11 This bill:
12 ▸ prohibits a health benefit plan from requiring step therapy for certain drugs used to
13 treat stage-IV advanced metastatic cancer or associated conditions.
14 Money Appropriated in this Bill:
16 Other Special Clauses:
18 Utah Code Sections Affected:
20 31A-22-641, as enacted by Laws of Utah 2013, Chapter 164
22 Be it enacted by the Legislature of the state of Utah:
23 Section 1. Section 31A-22-641 is amended to read:
24 31A-22-641. Cancer treatment parity -- Prohibition on step therapy for certain
25 cancer treatment.
26 (1) For purposes of this section:
27 (a) "Cost sharing" means the enrollee's maximum out-of-pocket costs as defined by the
28 health benefit plan.
29 (b) "Health insurer" is as defined in Subsection 31A-22-634(1).
30 (c) "Intravenously administered chemotherapy" means a physician-prescribed cancer
31 treatment that is used to kill or slow the growth of cancer cells, that is administered through
32 injection directly into the patient's circulatory system by a physician, physician assistant, nurse
33 practitioner, nurse, or other medical personnel under the supervision of a physician, and in a
34 hospital, medical office, or other clinical setting.
35 (d) "Oral chemotherapy" means a United States Food and Drug
36 Administration-approved, physician-prescribed cancer treatment that is used to kill or slow the
37 growth of cancer cells, that is taken orally in the form of a tablet or capsule, and may be
38 administered in a hospital, medical office, or other clinical setting or may be delivered to the
39 patient for self-administration under the direction or supervision of a physician outside of a
40 hospital, medical office, or other clinical setting.
41 (2) (a) This [
42 into on or after October 1, 2013.
44 intravenously administered chemotherapy shall:
46 applied to the covered oral chemotherapy is no more restrictive than the cost sharing applied to
47 the covered intravenously administered chemotherapy; or
49 sharing for intravenous chemotherapy, the health benefit plan may not apply cost sharing for
50 the oral chemotherapy that exceeds $300 per filled prescription.
52 administered chemotherapy for the purpose of achieving compliance with this section.
54 63G, Chapter 3, Utah Administrative Rulemaking Act, to enforce the provisions of this section.
55 (3) (a) This Subsection (3) applies to a health benefit plan entered into or renewed on
56 or after January 1, 2020.
57 (b) A health benefit plan may not make coverage of a prescription drug dependent on
58 the completion of a fail-first or other step therapy protocol if use of the prescription drug is:
59 (i) approved by the United States Food and Drug Administration;
60 (ii) indicated for treatment of stage-IV advanced metastatic cancer by:
61 (A) the United States Food and Drug Administration; or
62 (B) the National Comprehensive Cancer Network Drugs and Biologics Compendium;
63 (iii) for treatment of the enrollee's stage-IV advanced metastatic cancer or an associated
64 condition; and
65 (iv) supported by peer-reviewed medical literature.