Bill > LD178

This bill introduces new provisions regarding health insurance coverage for patients with metastatic cancer by first defining key terms and then prohibiting step therapy protocols for such patients. Specifically, the bill defines "associated conditions" as symptoms or side effects related to metastatic cancer that could further harm a patient if left untreated, and defines "metastatic cancer" as cancer that has spread from its original site to other parts of the body. The bill prevents health insurance carriers and utilization review organizations from requiring patients with metastatic cancer to go through step therapy (a process where patients must try less expensive medications before accessing more specialized treatments) before covering a prescription drug that has been approved by the FDA. This means patients with metastatic cancer can more quickly access potentially life-saving medications without having to first prove that less expensive or alternative treatments are ineffective. The bill includes a small fiscal note allocating modest funds ($7,176 from the General Fund and $2,496 from the Highway Fund) for administrative costs, and the new requirements will apply to health plans issued or renewed on or after January 1, 2026.

Health and Social Services

https://legislature.maine.gov/legis/bills/display_ps.asp?LD=178&snum=132