Legislative Analysis
Phone: (517) 373-8080
ORALLY ADMINISTERED ANTICANCER MEDICATIONS
http://www.house.mi.gov/hfa
House Bill 4354 (H-1) as reported from committee Analysis available at
Sponsor: Rep. Daire Rendon http://www.legislature.mi.gov
Committee: Insurance
Complete to 3-23-21
SUMMARY:
House Bill 4354 would amend the Insurance Code to prohibit a health insurance policy from
applying financial requirements to orally administered anticancer medications that are more
restrictive than the financial requirements it applies to intravenously administered or injected
anticancer medications. However, this would not apply if the co-pay or coinsurance for orally
administered anticancer medications under the policy were $150 or less per 30-day supply.
Under the bill, a health insurance policy delivered, issued for delivery, or renewed in Michigan
after December 31, 2022, that provides coverage for prescribed orally administered anticancer
medications and intravenously administered or injected anticancer medications would have to
ensure either of the following:
• That financial requirements applicable to prescribed orally administered anticancer
medications are not more restrictive than those that apply to intravenously administered or
injected anticancer medications that are covered by the policy.
• That the co-pay or coinsurance for orally administered anticancer medication does not
exceed $150 per 30-day supply. (The Department of Insurance and Financial Services
would have to adjust this dollar amount annually, beginning January 1, 2024, by the amount
determined by the state treasurer to reflect the cumulative annual change in the prescription
drug index of the medical care component of the U.S. Consumer Price Index.)
The bill would provide that an insurer could not achieve compliance with these requirements
by increasing cost-sharing requirements, reclassifying benefits with respect to anticancer
medications, or imposing more restrictive treatment limitations on prescribed orally
administered anticancer medications or intravenously administered or injected anticancer
medications that are covered under the policy. However, the provisions of the bill would not
prohibit an insurer from applying utilization management techniques.
Cost-sharing requirement would mean deductibles, copayments, coinsurance, out-of-
pocket expenses, aggregate lifetime limits, and annual limits.
Treatment limitation would mean limits on the frequency of treatment, days of coverage,
or other similar limits on the scope or duration of treatment. Treatment limitation would
not include the application of utilization management techniques.
Utilization management techniques would include prior authorization, step therapy [a
requirement that certain drugs be tried to treat a medical condition before other drugs are
covered], limits on quantity dispensed, and days’ supply per fill for any administered
anticancer medication.
House Fiscal Agency Page 1 of 2
 The bill could not take effect unless House Bill 4347 were also enacted. (House Bill 4347
would create a new act, the Drug Manufacturer Data Reporting Act, which would require drug
manufacturers to disclose certain information on costs and pricing to the Department of
Insurance and Financial Services on an annual basis.)
Proposed MCL 500.3406v
FISCAL IMPACT:
The bill would have a minimal fiscal cost for state and local employee health insurance, as any
reduced employee out-of-pocket costs for anticancer medications would likely be offset by
increases in health insurance premium rates that are at least partially paid for by the state or
local unit of government. Medicaid has strict cost-sharing limits, so this bill would not have a
fiscal impact on the state Medicaid program.
POSITIONS:
Representatives of the following entities testified in support of the bill:
• Michigan Society of Hematology and Oncology (3-18-21)
• American Cancer Society Cancer Action Network (3-11-21)
The following entities indicated support for the bill:
• American Lung Association (3-4-21)
• Bristol Meyers Squibb (3-4-21)
• Munson Healthcare (3-11-21)
• Leukemia and Lymphoma Society (3-11-21)
• Association for Clinical Oncology (3-3-21)
Representatives of the following entities testified in opposition to the bill:
• Economic Alliance for Michigan (3-4-21)
• Michigan Association of Health Plans (3-11-21)
The following entities indicated opposition to the bill:
• Michigan Manufacturers Association (3-18-21)
• Small Business Association of Michigan (3-4-21)
• Detroit Regional Chamber (3-4-21)
• NFIB Michigan (3-4-21)
• Grand Rapids Chamber of Commerce (3-4-21)
• Michigan Chamber of Commerce (3-4-21)
• Saginaw County Chamber of Commerce (3-4-21)
• Blue Cross Blue Shield of Michigan (3-4-21)
Legislative Analyst: Rick Yuille
Fiscal Analyst: Kevin Koorstra
■ 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 4354 (H-1) as reported Page 2 of 2


Statutes affected:
House Introduced Bill: 500.100, 500.8302
As Passed by the House: 500.100, 500.8302