Legislative Analysis
Phone: (517) 373-8080
ORALLY ADMINISTERED ANTICANCER MEDICATIONS
http://www.house.mi.gov/hfa
House Bill 4071 as enacted Analysis available at
Public Act 170 of 2023 http://www.legislature.mi.gov
Sponsor: Rep. Samantha Steckloff
House Committee: Health Policy
Senate Committee: Health Policy
Complete to 2-15-24
SUMMARY:
House Bill 4071 amends the Insurance Code to prohibit a health insurance policy from applying
financial requirements to orally administered (by mouth) anticancer medications that are more
restrictive than the requirements it applies to anticancer medications that are administered or
injected intravenously (into a vein). However, the above prohibition only applies if the co-pay
or coinsurance for orally administered anticancer medications under the policy is more than
$250 for a 30-day supply.
Under the bill, a health insurance policy delivered, issued, or renewed in Michigan after
December 31, 2025, that provides coverage for prescribed orally administered antineoplastic 1
medications and intravenously administered or injected antineoplastic medications must ensure
either of the following:
• Financial requirements that apply to prescribed orally administered antineoplastic
medications are not more restrictive than those that apply to intravenously
administered or injected antineoplastic medications covered by the policy.
• The co-pay or coinsurance for orally administered antineoplastic medication does
not exceed $250 per 30-day supply. 2
An insurer cannot comply with these requirements by increasing cost-sharing requirements,
by reclassifying benefits with respect to antineoplastic medications, or by imposing more
restrictive treatment limitations on prescribed orally administered antineoplastic medications
or intravenously administered or injected antineoplastic medications covered under the policy.
However, the bill does not prohibit an insurer from applying utilization management
techniques.
Cost-sharing requirement means deductibles, copayments, coinsurance, out-of-pocket
expenses, aggregate lifetime limits, and annual limits.
Treatment limitation means limits on the frequency of treatment, days of coverage, or
other similar limits on the scope or duration of treatment. Treatment limitation does
not include the application of utilization management techniques.
1
Antineoplastic means inhibiting or preventing the growth and spread of tumors (neoplasms).
2
Beginning January 1, 2026, this dollar amount must be adjusted annually to reflect the cumulative annual change in
the prescription drug index of the medical care component of the U.S. Consumer Price Index.
House Fiscal Agency Page 1 of 3
 Utilization management techniques includes prior authorization, step therapy (i.e.,
requiring certain drugs to be tried to treat a medical condition before other drugs are
covered), limits on quantity dispensed, and days’ supply per fill for any administered
antineoplastic medication.
MCL 500.3406v
BACKGROUND:
House Bill 4071 is a reintroduction of HB 4354 of the 2021-22 legislative session, as passed
by the House of Representatives. Similar bills have been introduced each session beginning
with the 2009-10 legislative session.
BRIEF DISCUSSION:
House Bill 4071 addresses what some see as unfairness in how health insurers provide coverage
for oral anticancer medications and medications that are infused or injected. Anticancer
medications that are infused or injected fall under the medical benefits of a health plan, while
oral medications fall under the pharmacy benefits. In some health plans, the cost-sharing
structure—the amount a beneficiary pays in deductibles, co-pays, co-insurance, and maximum
out-of-pocket costs—can differ greatly between medical and pharmacy benefits. For example,
many medical policies set a flat co-pay or, after an annual deductible is met, require a small
percentage of the cost of an office visit or medical test, with an annual maximum cap on out-
of-pocket expenses. On the pharmacy side, however, a plan may require coinsurance as high
as 50% per drug with no annual out-of-pocket maximum. In the case of oral anticancer drugs,
which can run in the tens of thousands each month, paying 20%, 30%, or 50% of a life-saving
treatment per month is unattainable for many. Even if a plan does have a cap on annual drug
costs, due to the high cost of anticancer medications, even one month’s cost share may be too
much for a patient to afford.
The bill would provide parity in how anticancer medications are treated. If a policy offered
anticancer medications as a covered benefit, cost-sharing would have to be the same whether
the medication was an infused or injected drug or one taken by mouth. The bill would thus
refocus cancer treatment on the best therapy for the patient and the type of cancer the patient
has, not on which anticancer medication the patient’s health insurance covers is the most
affordable.
Forty-three states and the District of Columbia offer some sort of cancer-drug parity. According
to committee testimony, those states have seen negligible impacts on the cost of premiums
while at the same time making oral cancer drugs more accessible. In many cases, oral cancer
medications are less costly, and in some cases, an oral cancer drug may be the only treatment
for a particular cancer or may be the standard treatment of care, being more effective than a
more costly infused or injected drug. In addition, infused or injected chemo drugs can be harsh,
with such debilitating side effects that patients may lose their jobs due to absenteeism. Because
oral cancer drugs tend to be less toxic, patients often report fewer side effects than with the
infused counterparts, meaning cancer patients are able to have a higher quality of life and can
continue to work, care for their families, and live productive lives.
House Fiscal Agency HB 4071 as enacted Page 2 of 3
 Not all believe that the bill is the right path to establish cancer-drug parity. For example, few
Michigan residents would benefit under the bill. This is because most people with insurance
are covered under large employer-sponsored health plans that are self-funded and therefore
regulated under the federal Employee Retirement Income Security Act (ERISA) rather than
the state Insurance Code. In addition, Medicaid, Medicare, and Tricare (health insurance for
members of the military, retirees, and their dependents) are also not subject to Michigan’s
insurance laws. Reportedly, 65% of cancer patients are covered by Medicaid. With so few
likely to benefit from the bill, opponents say a better approach would be to tackle the
underlying structure of drug pricing and the way federal law first defined drugs as a medical
benefit or a drug benefit when designing Part D for Medicare enrollees. Moreover, with drug
prices across the board increasing annually, restricting how an insurer sets cost-sharing may
have the greatest impact on small employers and individuals buying health insurance. Small
employers are more likely than large employers to eliminate insurance for their employees, and
individuals may find it difficult to maintain quality health insurance if premiums do eventually
rise.
FISCAL IMPACT:
House Bill 4071 would not have any noteworthy direct fiscal impact on the Department of
Insurance and Financial Services, which would be responsible under the bill for annually
adjusting the maximum allowable co-pay or coinsurance for orally administered anticancer
medication. This activity would likely be sufficiently supported by existing appropriations.
Legislative Analyst: Rick Yuille
Fiscal Analyst: Marcus Coffin
■ This analysis was prepared by nonpartisan House Fiscal Agency staff for use by House members in their
deliberations and does not constitute an official statement of legislative intent.
House Fiscal Agency HB 4071 as enacted Page 3 of 3


Statutes affected:
Substitute (H-1): 500.100, 500.8302
Substitute (S-1): 500.100, 500.8302
House Introduced Bill: 500.100, 500.8302
As Passed by the House: 500.100, 500.8302
As Passed by the Senate: 500.100, 500.8302
House Concurred Bill: 500.100, 500.8302
Public Act: 500.100, 500.8302
House Enrolled Bill: 500.100, 500.8302