HOUSE BILL NO. 5204

November 04, 2025, Introduced by Reps. B. Carter, Longjohn, Rheingans, McFall, Hope, Weiss, Koleszar, Young, Dievendorf, Wilson, Johnsen, Myers-Phillips, Breen, Miller, Byrnes, MacDonell, Martus, Paiz, Brixie, Grant, Conlin, Snyder, Pohutsky, Mentzer, Hoskins, Price, Edwards, O'Neal, Neeley, McKinney, Steckloff, Andrews, Coffia and Fitzgerald and referred to Committee on Insurance.

A bill to amend 1956 PA 218, entitled

"The insurance code of 1956,"

(MCL 500.100 to 500.8302) by adding section 3406rr.

the people of the state of michigan enact:

Sec. 3406rr. (1) An insurer that delivers, issues for delivery, or renews in this state a health insurance policy that provides coverage for prescription drugs for advanced metastatic cancer and associated conditions shall not require, before coverage is provided, that an enrollee do either of the following:

(a) Fail to successfully respond to a different prescription drug.

(b) Prove a history of failure of a different prescription drug.

(2) As used in this section:

(a) "Advanced 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.

(b) "Associated conditions" means the symptoms or side effects associated with advanced metastatic cancer or its treatment, that, in the judgment of the health care provider, further jeopardize the health of the patient if left untreated.