Hawaii 2022 Regular Session

Hawaii Senate Bill SB218 Compare Versions

Only one version of the bill is available at this time.

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1	1	THE SENATE S.B. NO. 218 THIRTY-FIRST LEGISLATURE, 2021 STATE OF HAWAII A BILL FOR AN ACT RELATING TO HEALTH CARE INSURANCE. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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3	3	THE SENATE S.B. NO. 218
4	4	THIRTY-FIRST LEGISLATURE, 2021
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7	7	THE SENATE
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9	9	S.B. NO.
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13	13	THIRTY-FIRST LEGISLATURE, 2021
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17	17	STATE OF HAWAII
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31	31	A BILL FOR AN ACT
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37	37	RELATING TO HEALTH CARE INSURANCE.
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43	43	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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47	47	SECTION 1. The legislature finds that the department of health reports cancer as the second leading cause of death among Hawaii residents, claiming more than two thousand two hundred Hawaii residents each year. The legislature further finds that cancer patients should have full access to effective treatment options at early stages of their illnesses. Step therapy policies delay getting cancer patients the right drug or treatment at the right time, and treatments are far too often health plan- or provider-centered, rather than patient-centered. The purpose of this Act is to: (1) Prohibit health insurers that cover treatment for stage two through stage four cancer from requiring an insured diagnosed with stage two through stage four cancer to undergo step therapy prior to covering the insured for the drug prescribed by the insured's health care provider, under certain conditions; and (2) Require the auditor to conduct an impact assessment report to assess the social and financial impacts of the mandated health insurance coverage. SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to part I of article 10A to be appropriately designated and to read as follows: "§431:10A- Step therapy prohibited; stage two through stage four cancer. (a) No individual policy of accident and health or sickness insurance issued or renewed in the State after December 31, 2021, that provides coverage for the treatment of stage two through stage four cancer shall require an insured who is diagnosed with a stage two through stage four cancer to undergo step therapy prior to covering the drug prescribed by the insured's health care provider if the prescribed drug is a prescription drug: (1) That is approved by the United States Food and Drug Administration; (2) Whose use is consistent with best practices for the treatment of the cancer or treatment of side effects of the cancer; (3) That is listed in one of the approved compendia; (4) That is supported by a published peer-reviewed study as a recognized off-label use for the treatment of the cancer or treatment of side effects of the cancer; or (5) That is listed on the insurer's prescription drug formulary. (b) For the purposes of this section, "step therapy" means a protocol that requires an insured to use a prescription drug or sequence of prescription drugs, other than the drug that the insured's health care provider recommends for the insured's treatment, before the insurer provides coverage for the recommended prescription drug." SECTION 3. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to part II of article 10A to be appropriately designated and to read as follows: "§431:10A- Step therapy prohibited; stage two through stage four cancer. (a) No group policy of accident and health or sickness insurance issued or renewed in the State after December 31, 2021, that provides coverage for the treatment of stage two through stage four cancer shall require an insured who is diagnosed with a stage two through stage four cancer to undergo step therapy prior to covering the drug prescribed by the insured's health care provider if the prescribed drug is a prescription drug: (1) That is approved by the United States Food and Drug Administration; (2) Whose use is consistent with best practices for the treatment of the cancer or treatment of side effects of the cancer; (3) That is listed in one of the approved compendia; (4) That is supported by a published peer-reviewed study as a recognized off-label use for the treatment of the cancer or treatment of side effects of the cancer; or (5) That is listed on the insurer's prescription drug formulary. (b) For the purposes of this section, "step therapy" means a protocol that requires an insured to use a prescription drug or sequence of prescription drugs, other than the drug that the insured's health care provider recommends for the insured's treatment, before the insurer provides coverage for the recommended prescription drug." SECTION 4. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to part VI of article 1 to be appropriately designated and to read as follows: "§432:1- Step therapy prohibited; stage two through stage four cancer. (a) No individual or group hospital or medical service plan contract issued or renewed in the State after December 31, 2021, that provides coverage for the treatment of stage two through stage four cancer shall require a subscriber or member who is diagnosed with a stage two through stage four cancer to undergo step therapy prior to covering the drug prescribed by the subscriber's or member's health care provider if the prescribed drug is a prescription drug: (1) That is approved by the United States Food and Drug Administration; (2) Whose use is consistent with best practices for the treatment of the cancer or treatment of side effects of the cancer; (3) That is listed in one of the approved compendia; (4) That is supported by a published peer-reviewed study as a recognized off-label use for the treatment of the cancer or treatment of side effects of the cancer; or (5) That is listed on the mutual benefit society's prescription drug formulary. (b) For the purposes of this section, "step therapy" means a protocol that requires a subscriber or member to use a prescription drug or sequence of prescription drugs, other than the drug that the subscriber's or member's health care provider recommends for the subscriber's or member's treatment, before the mutual benefit society provides coverage for the recommended prescription drug." SECTION 5. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows: "§432D- Step therapy prohibited; stage two through stage four cancer. (a) No policy, contract, plan, or agreement issued or renewed in the State after December 31, 2021, that provides coverage for the treatment of stage two through stage four cancer shall require an enrollee who is diagnosed with a stage two through stage four cancer to undergo step therapy prior to covering the drug prescribed by the enrollee's health care provider if the prescribed drug is a prescription drug: (1) That is approved by the United States Food and Drug Administration; (2) Whose use is consistent with best practices for the treatment of the cancer or treatment of side effects of the cancer; (3) That is listed in one of the approved compendia; (4) That is supported by a published peer-reviewed study as a recognized off-label use for the treatment of the cancer or treatment of side effects of the cancer; or (5) That is listed on the health maintenance organization's prescription drug formulary. (b) For the purposes of this section, "step therapy" means a protocol that requires an enrollee to use a prescription drug or sequence of prescription drugs, other than the drug that the enrollee's health care provider recommends for the enrollee's treatment, before the health maintenance organization provides coverage for the recommended prescription drug." SECTION 6. (a) The auditor shall conduct an impact assessment report pursuant to sections 23-51 and 23-52, Hawaii Revised Statutes, to assess the social and financial impacts of the mandate specified in sections 2, 3, 4, and 5 of this Act. (b) The auditor shall submit a report of its findings and recommendations, including any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2022. SECTION 7. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date. SECTION 8. New statutory material is underscored. SECTION 9. This Act shall take effect on July 1, 2021. INTRODUCED BY: _____________________________
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49	49	SECTION 1. The legislature finds that the department of health reports cancer as the second leading cause of death among Hawaii residents, claiming more than two thousand two hundred Hawaii residents each year. The legislature further finds that cancer patients should have full access to effective treatment options at early stages of their illnesses. Step therapy policies delay getting cancer patients the right drug or treatment at the right time, and treatments are far too often health plan- or provider-centered, rather than patient-centered.
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51	51	The purpose of this Act is to:
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53	53	(1) Prohibit health insurers that cover treatment for stage two through stage four cancer from requiring an insured diagnosed with stage two through stage four cancer to undergo step therapy prior to covering the insured for the drug prescribed by the insured's health care provider, under certain conditions; and
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55	55	(2) Require the auditor to conduct an impact assessment report to assess the social and financial impacts of the mandated health insurance coverage.
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57	57	SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to part I of article 10A to be appropriately designated and to read as follows:
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59	59	"§431:10A- Step therapy prohibited; stage two through stage four cancer. (a) No individual policy of accident and health or sickness insurance issued or renewed in the State after December 31, 2021, that provides coverage for the treatment of stage two through stage four cancer shall require an insured who is diagnosed with a stage two through stage four cancer to undergo step therapy prior to covering the drug prescribed by the insured's health care provider if the prescribed drug is a prescription drug:
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61	61	(1) That is approved by the United States Food and Drug Administration;
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63	63	(2) Whose use is consistent with best practices for the treatment of the cancer or treatment of side effects of the cancer;
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65	65	(3) That is listed in one of the approved compendia;
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67	67	(4) That is supported by a published peer-reviewed study as a recognized off-label use for the treatment of the cancer or treatment of side effects of the cancer; or
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69	69	(5) That is listed on the insurer's prescription drug formulary.
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71	71	(b) For the purposes of this section, "step therapy" means a protocol that requires an insured to use a prescription drug or sequence of prescription drugs, other than the drug that the insured's health care provider recommends for the insured's treatment, before the insurer provides coverage for the recommended prescription drug."
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73	73	SECTION 3. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to part II of article 10A to be appropriately designated and to read as follows:
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75	75	"§431:10A- Step therapy prohibited; stage two through stage four cancer. (a) No group policy of accident and health or sickness insurance issued or renewed in the State after December 31, 2021, that provides coverage for the treatment of stage two through stage four cancer shall require an insured who is diagnosed with a stage two through stage four cancer to undergo step therapy prior to covering the drug prescribed by the insured's health care provider if the prescribed drug is a prescription drug:
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77	77	(1) That is approved by the United States Food and Drug Administration;
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79	79	(2) Whose use is consistent with best practices for the treatment of the cancer or treatment of side effects of the cancer;
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81	81	(3) That is listed in one of the approved compendia;
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83	83	(4) That is supported by a published peer-reviewed study as a recognized off-label use for the treatment of the cancer or treatment of side effects of the cancer; or
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85	85	(5) That is listed on the insurer's prescription drug formulary.
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87	87	(b) For the purposes of this section, "step therapy" means a protocol that requires an insured to use a prescription drug or sequence of prescription drugs, other than the drug that the insured's health care provider recommends for the insured's treatment, before the insurer provides coverage for the recommended prescription drug."
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89	89	SECTION 4. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to part VI of article 1 to be appropriately designated and to read as follows:
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91	91	"§432:1- Step therapy prohibited; stage two through stage four cancer. (a) No individual or group hospital or medical service plan contract issued or renewed in the State after December 31, 2021, that provides coverage for the treatment of stage two through stage four cancer shall require a subscriber or member who is diagnosed with a stage two through stage four cancer to undergo step therapy prior to covering the drug prescribed by the subscriber's or member's health care provider if the prescribed drug is a prescription drug:
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93	93	(1) That is approved by the United States Food and Drug Administration;
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95	95	(2) Whose use is consistent with best practices for the treatment of the cancer or treatment of side effects of the cancer;
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97	97	(3) That is listed in one of the approved compendia;
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99	99	(4) That is supported by a published peer-reviewed study as a recognized off-label use for the treatment of the cancer or treatment of side effects of the cancer; or
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101	101	(5) That is listed on the mutual benefit society's prescription drug formulary.
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103	103	(b) For the purposes of this section, "step therapy" means a protocol that requires a subscriber or member to use a prescription drug or sequence of prescription drugs, other than the drug that the subscriber's or member's health care provider recommends for the subscriber's or member's treatment, before the mutual benefit society provides coverage for the recommended prescription drug."
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105	105	SECTION 5. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
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107	107	"§432D- Step therapy prohibited; stage two through stage four cancer. (a) No policy, contract, plan, or agreement issued or renewed in the State after December 31, 2021, that provides coverage for the treatment of stage two through stage four cancer shall require an enrollee who is diagnosed with a stage two through stage four cancer to undergo step therapy prior to covering the drug prescribed by the enrollee's health care provider if the prescribed drug is a prescription drug:
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109	109	(1) That is approved by the United States Food and Drug Administration;
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111	111	(2) Whose use is consistent with best practices for the treatment of the cancer or treatment of side effects of the cancer;
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113	113	(3) That is listed in one of the approved compendia;
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115	115	(4) That is supported by a published peer-reviewed study as a recognized off-label use for the treatment of the cancer or treatment of side effects of the cancer; or
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117	117	(5) That is listed on the health maintenance organization's prescription drug formulary.
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119	119	(b) For the purposes of this section, "step therapy" means a protocol that requires an enrollee to use a prescription drug or sequence of prescription drugs, other than the drug that the enrollee's health care provider recommends for the enrollee's treatment, before the health maintenance organization provides coverage for the recommended prescription drug."
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121	121	SECTION 6. (a) The auditor shall conduct an impact assessment report pursuant to sections 23-51 and 23-52, Hawaii Revised Statutes, to assess the social and financial impacts of the mandate specified in sections 2, 3, 4, and 5 of this Act.
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123	123	(b) The auditor shall submit a report of its findings and recommendations, including any proposed legislation, to the legislature no later than twenty days prior to the convening of the regular session of 2022.
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125	125	SECTION 7. This Act does not affect rights and duties that matured, penalties that were incurred, and proceedings that were begun before its effective date.
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127	127	SECTION 8. New statutory material is underscored.
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129	129	SECTION 9. This Act shall take effect on July 1, 2021.
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133	133	INTRODUCED BY: _____________________________
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135	135	INTRODUCED BY:
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137	137	_____________________________
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143	143	Report Title: Health Care Insurance; Step Therapy; Auditor; Impact Assessment Report Description: Prohibits a health care insurer, mutual benefit society, or health maintenance organization from requiring an insured, subscriber, member, or enrollee diagnosed with stage two through stage four cancer to undergo step therapy prior to covering the insured for the drug prescribed by the insured's health care provider, under certain conditions, for health insurance policies and contracts issued or renewed after 12/31/2021. Requires Auditor to conduct impact assessment report on mandated health insurance coverage. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.
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149	149	Report Title:
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151	151	Health Care Insurance; Step Therapy; Auditor; Impact Assessment Report
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155	155	Description:
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157	157	Prohibits a health care insurer, mutual benefit society, or health maintenance organization from requiring an insured, subscriber, member, or enrollee diagnosed with stage two through stage four cancer to undergo step therapy prior to covering the insured for the drug prescribed by the insured's health care provider, under certain conditions, for health insurance policies and contracts issued or renewed after 12/31/2021. Requires Auditor to conduct impact assessment report on mandated health insurance coverage.
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165	165	The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.