Bill > HB2536

This bill addresses step therapy restrictions for patients with advanced metastatic cancer by prohibiting health benefit plans from requiring step therapy (a practice where patients must try less expensive or lower-tier medications before insurance will cover a prescribed drug) prior to covering FDA-approved prescription drugs. The bill defines advanced metastatic cancer as cancer that has spread beyond its original site to other parts of the body, and includes associated conditions such as symptoms or side effects that could further harm a patient if left untreated. Specifically, the legislation mandates that health benefit plans covering advanced metastatic cancer must provide coverage for prescription drugs that are consistent with best medical practices and supported by peer-reviewed, evidence-based literature. The bill will apply to health benefit plans issued, offered, or renewed on or after January 1, 2026, effectively giving health insurers time to adjust their policies. By preventing step therapy for these complex cancer treatments, the bill aims to ensure that patients can more quickly access potentially life-saving or life-extending medications recommended by their healthcare providers.

Health and Social Services

https://olis.oregonlegislature.gov/liz/2025R1/Measures/Overview/HB2536