Bill Summary – FastDemocracy

                                                                   APPROVED                  CHAPTER
                                                                    JULY 1, 2025                  448
                                                                  BY GOVERNOR               PUBLIC LAW
                                   STATE OF MAINE
                                           _____
                           IN THE YEAR OF OUR LORD
                        TWO THOUSAND TWENTY-FIVE
                                           _____
                                   H.P. 111 - L.D. 178
     An Act Regarding Coverage for Step Therapy for Metastatic Cancer
Be it enacted by the People of the State of Maine as follows:
    Sec. 1. 24-A MRSA §4320-N, sub-§1, ¶A-1 is enacted to read:
    A-1. "Associated conditions" means the symptoms or side effects associated with
    metastatic cancer or its treatment and that, in the judgment of the health care
    practitioner, further jeopardize the health of a patient if left untreated.
    Sec. 2. 24-A MRSA §4320-N, sub-§1, ¶C-1 is enacted to read:
    C-1. "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.
    Sec. 3. 24-A MRSA §4320-N, sub-§8 is enacted to read:
    8. Step therapy for metastatic cancer and associated conditions prohibited.
Notwithstanding subsection 6, paragraph B, with respect to coverage of a prescription drug
on a carrier's formulary for the treatment of metastatic cancer and associated conditions, a
carrier or utilization review organization may not require that the enrollee use a step therapy
protocol before the carrier provides coverage of a prescription drug approved by the United
States Food and Drug Administration.
    Sec. 4. Appropriations and allocations. The following appropriations and
allocations are made.
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF
Departments and Agencies - Statewide 0016
Initiative: Provides funding to allow enrollees to use step therapy protocols before the
carrier provides coverage of prescription drugs approved by the United States Food and
Drug Administration. The expanded requirements apply to health plans issued or renewed
on or after January 1, 2026.
GENERAL FUND                                                       2025-26          2026-27
 All Other                                                              $0            $7,176
                                                                __________       __________
                                    Page 1 - 132LR0578(03)
GENERAL FUND TOTAL                                    $0       $7,176
HIGHWAY FUND                                     2025-26      2026-27
 All Other                                            $0        $2,496
                                              __________   __________
HIGHWAY FUND TOTAL                                    $0        $2,496
                     Page 2 - 132LR0578(03)
