HB 858

ON MARCH 31, 2025, THE HOUSE ADOPTED AMENDMENT #1 AND PAS SED HOUSE BILL 858, AS AMENDED. AMENDMENT #1 rewrites the bill to, instead, make the following revisions to present law:  Generally prohibits a health benefit plan that provides coverage for stage 4 advanced metastatic cancer, blood cancer, and associated conditions from requiring use of a step therapy protocol before the health benefit plan provides coverage of an approved prescription drug to an enrollee who has received a diagnosis of stage 4 advanced metastatic cancer or blood cancer.  Requires, for an approved prescription drug prescribed for an associated condition, the treating healthcare provider to inform the health benefit plan that the condition is an associated condition of stage 4 advanced metastatic cancer or blood cancer when requesting authorization.  Requires each treating healthcare provider who prescribes an approved prescription drug to a patient pursuant to such process to submit an annual report to the department of health by such date and in such manner as the commissioner of health may prescribe by rule, that includes the number of stage 4 advanced metastatic cancer and blood cancer cases treated, the approved prescription drug involved in treatment, and the overall six-month survival rate for the cases treated.  Applies the provisions described above to policies or agreements entered into, renewed, or amended on or after January 1, 2026.  Exempts group insurance plans offered to employees of this state and political subdivisions of this state from complying with the provisions described above.  Clarifies that the provisions described above do not prevent a health carrier, health benefit plan, or utilization review organization from requiring a patient to try an AB-rated generic equivalent product, interchangeable biological product, or biosimilar product prior to providing coverage for the equivalent branded prescription drug.  Defines, for purposes of the provisions described above, an "approved prescription drug"" as a prescription drug that is (i) approved by the United States food and drug administration; (ii) consistent with best practices for the treatment of stage 4 advanced metastatic cancer or blood cancer; (iii) supported by peer-reviewed, evidence-based literature consistent with the National Comprehensive Cancer Network Drugs and Biologics Compendium for the treatment of stage 4 advanced metastatic cancer or blood cancer; and (iv) on the health benefit plan's prescription drug formulary.  Requires the commissioner of commerce and insurance and the commissioner of health to promulgate rules to effectuate this amendment. ON APRIL 16, 2025, THE SENATE SUBSTITUTED HOUSE BILL 858 FOR SENATE BILL 1382, ADOPTED AMENDMENT #1, AND PASSED HOUSE BILL 858, AS AMENDED. AMENDMENT #1 includes metastatic blood cancer as another cancer covered by the bill."