Step Therapy Prohibition For Stage Four Metastatic Cancer

MIKE CHANEY Commissioner of Insurance State Fire Marshal DAVID BROWNING Deputy Commissioner of Insurance MISSISSIPPI INSURANCE DEPARTMENT 501 N. WEST STREET, SUITE 1001 WOOLFOLK BUILDING JACKSON, MISSISSIPPI 39201 www.mld.ms.gov MISSISSIPPI DEPARTMENT OF INSURANCE BULLETIN 2026-7 MAILING AODRESS Post Office Box 79 Jackson, Mississippi 39205-0079 TELEPHONE: (601) 359-3569 FAX: (601) 359-2474 WATS: 1-800-562-2957 (Incoming-USA) STEP THERAPY PROHIBITION FOR STAGE FOUR METASTATIC CANCER May 21, 2026 I. Scope and Legislative Action. This Bulletin is issued to any insurer as defined in Miss. Code Ann. § 83-9-36(3)(a) 1. During the 2024 Regular Legislative Session, the Legislature passed House Bill 1143, which provided that all health benefit plans that directly or indirectly cover the treatment of stage four advanced, metastatic cancer and any associated conditions were prohibited from utilizing step therapy or fail first protocol for the treatment of stage four advanced metastatic cancer. The provisions ofHB 1143 are codified in Miss. Code Ann.§§ 83-9-8.1 and 83-9-36. House Bill 1143 included a two year repealer and Miss. Code Ann. §§ 83-9-8.1 and 83-9-36 were set for repeal on June 30, 2026, However, during the 2026 Regular Legislative Session, the Legislature passed House Bill 856 which completely removed the repealer. As a result of the recent legislative action, the Mississippi Insurance Department (MID) issues this Bulletin to remind health plans of their obligation to comply with applicable Mississippi law. II. Step Therapy Prohibition. Miss. Code Ann. §§ 83-9-8.1 and 83-9-36 prohibit any health benefit plan2 from utilizing step therapy or fail first protocol for the treatment of stage four advanced, metastatic cancer.3 While health plans may ensure that the use of a drug is consistent with best practices for the treatment of stage four advanced, metastatic cancer and is supported by peer-reviewed medical literature, a health benefit plan that directly or indirectly covers the treatment of stage four advanced, metastatic cancer may not limit or exclude coverage for an FDA-approved drug. 1 Miss. Code Ann. §83-9-36(3)(a) "Insurer" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract or agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type, including a group insurance plan. However, the term "insurer" does not include a preferred provider organization that is only a network of providers and does not define health care benefits for the purpose of coverage under a health care benefits plan. 2 Miss Code Ann. §83-9-8.l(l)(c) "Health benefit plan" means a policy, contract, certificate or agreement entered into, offered by or issued by an insurer to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services. 3 Miss. Code A1111. §83-9-8.l(l)(b) "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.