Advanced, metastatic cancer; delete repealer on prohibition against health plans requiring step therapy before covering certain drugs to treat., the official text

MISSISSIPPI LEGISLATURE

2026 Regular Session

To: Public Health and Human Services

By: Representatives Felsher, Scott

House Bill 856

(As Sent to Governor)

AN ACT TO REENACT SECTION 83-9-8.1, MISSISSIPPI CODE OF
1972, WHICH PROHIBITS A HEALTH BENEFIT PLAN FROM REQUIRING STEP THERAPY OR FAIL-FIRST
PROTOCOLS BEFORE THE PLAN PROVIDES COVERAGE OF CERTAIN PRESCRIPTION DRUGS TO
TREAT ADVANCED, METASTATIC CANCER AND ASSOCIATED CONDITIONS; TO REENACT SECTION
83-9-36, MISSISSIPPI CODE OF 1972, WHICH PRESCRIBES THE PROCESS BY WHICH A
PRESCRIBING PRACTITIONER MAY REQUEST AN OVERRIDE OF AN INSURER'S RESTRICTION ON
MEDICATION FOR USE BY A STEP THERAPY OR FAIL-FIRST PROTOCOL; TO AMEND SECTION
3, CHAPTER 379, LAWS OF 2024, TO DELETE THE REPEALER ON SECTIONS 83-9-8.1 AND
83-9-36, MISSISSIPPI CODE OF 1972; AND FOR RELATED PURPOSES.

BE IT ENACTED BY THE
LEGISLATURE OF THE STATE OF MISSISSIPPI:

SECTION 1.  Section
83-9-8.1, Mississippi Code of 1972, is reenacted as follows:

83-9-8.1.  (1)  As used in
this section, the following terms shall be defined as provided in this
subsection:

(a)  "Associated
conditions" means the symptoms or side effects associated with advanced,
metastatic cancer or its treatment and which, in the judgment of the health
care practitioner, further jeopardizes the health of a patient if left
untreated.

(b)  "Advanced,
metastatic cancer" means cancer that has spread from the primary or
original site of the cancer to nearby tissues, lymph nodes, or other areas or
parts of the body.

(c)
"Health benefit plan" means a policy, contract, certificate or
agreement entered into, offered by or issued by an insurer to provide, deliver,
arrange for, pay for or reimburse any of the costs of health care services.

(2)  A health benefit plan
that provides coverage for advanced, metastatic cancer and associated
conditions may not require, before the health benefit plan provides coverage of
a prescription drug approved by the United States Food and Drug Administration,
that the enrollee:

(a)  Fail to
successfully respond to a different drug; or

(b)  Prove a history of
failure of a different drug.

(3)  This section applies
only to a drug the use of which is:

(a)  Consistent with
best practices for the treatment of advanced, metastatic cancer or an
associated condition;

(b)  Supported by peer-reviewed,
evidence-based literature; and

(c)  Approved by the
United States Food and Drug Administration.

SECTION 2.  Section
83-9-36, Mississippi Code of 1972, is reenacted as follows:

83-9-36.  (1)  When
medications for the treatment of any medical condition are restricted for use
by an insurer by a step therapy or fail-first protocol, the prescribing
practitioner shall have access to a clear and convenient process to
expeditiously request an override of that restriction from the insurer.  An
override of that restriction shall be expeditiously granted by the insurer
under the following circumstances:

(a)  The prescribing
practitioner can demonstrate, based on sound clinical evidence, that the
preferred treatment required under step therapy or fail-first protocol has been
ineffective in the treatment of the insured's disease or medical condition; or

(b)  Based on sound
clinical evidence or medical and scientific evidence:

(i)  The
prescribing practitioner can demonstrate that the preferred treatment required
under the step therapy or fail-first protocol is expected or likely to be
ineffective based on the known relevant physical or mental characteristics of
the insured and known characteristics of the drug regimen; or

(ii)  The
prescribing practitioner can demonstrate that the preferred treatment required
under the step therapy or fail-first protocol will cause or will likely cause
an adverse reaction or other physical harm to the insured.

(2)  The
duration of any step therapy or fail-first protocol shall not be longer than a
period of thirty (30) days when the treatment is deemed clinically ineffective
by the prescribing practitioner.  When the prescribing practitioner can
demonstrate, through sound clinical evidence, that the originally prescribed
medication is likely to require more than thirty (30) days to provide any
relief or an amelioration to the insured, the step therapy or fail-first
protocol may be extended up to seven (7) additional days.

(3)  As
used in this section:

(a)
"Insurer" means any hospital, health, or medical expense insurance
policy, hospital or medical service contract, employee welfare benefit plan,
contract or agreement with a health maintenance organization or a preferred
provider organization, health and accident insurance policy, or any other
insurance contract of this type, including a group insurance plan.  However,
the term "insurer" does not include a preferred provider organization
that is only a network of providers and does not define health care benefits
for the purpose of coverage under a health care benefits plan.

(b)
"Practitioner" has the same meaning as defined in Section 73-21-73.

(4)  The provisions of
Section 83-9-8.1 shall supersede the provisions of this section to the extent
of any conflict between Section 83-9-8.1 and this section.

SECTION 3.  Section
3, Chapter 379, Laws of 2024, is amended as follows:

Section 3.  This act
shall take effect and be in force from and after July 1, 2024 * * *, and shall stand repealed on June 30, 2026.

SECTION 4.  This act
shall take effect and be in force from and after June 30, 2026.