Bill > AB774

This bill prohibits insurance companies, pharmacy benefit managers, and utilization review organizations from requiring step therapy (a process where patients must try less expensive or alternative medications before the insurance will cover a prescribed drug) for specific cancer drugs. The bill defines key terms, including "cancer-associated condition" as any symptom or side effect related to metastatic cancer that could further harm a patient if left untreated, and "metastatic cancer" as cancer that has spread from its original site to other parts of the body. Specifically, the bill prevents these organizations from mandating step therapy for drugs that meet three criteria: (1) are approved by the Federal Food and Drug Administration, (2) are consistent with best practices for treating metastatic cancer or related conditions, and (3) are supported by peer-reviewed, evidence-based research publications. The aim of this legislation is to ensure that patients with metastatic cancer can more quickly access the most appropriate medications recommended by their healthcare providers without being forced to try alternative treatments first.

Health and Social Services

https://docs.legis.wisconsin.gov/2025/proposals/reg/asm/bill/ab774