HCS HB 531 -- INSURANCE COVERAGE FOR CERTAIN DRUGS

SPONSOR:  Auer (Troupe)

COMMITTEE ACTION:  Voted "do pass" by the Committee on Insurance
by a vote of 11 to 1.

The substitute prohibits insurers and health service
corporations from denying coverage of a drug based on the Food
and Drug Administration's (FDA) non-approval for an illness, if
the drug is recognized as effective for treating the illness by
the United States Pharmacopeia Drug Information, the American
Medical Association Drug Evaluations, the American Hospital
Formulary Service Drug Information, or peer-reviewed medical
literature. Insurers and health service corporations are not
required to cover: drugs that the FDA has not approved for any
use; drugs that the FDA has determined could be harmful; drugs
substantially equivalent to a drug which the insurer or health
service corporation has in its formulary; and drugs used in
research trials sponsored by the drug's manufacturer.

FISCAL NOTE:  Not available at time of this printing.

PROPONENTS:  Supporters say that the bill protects cancer
patients by prohibiting insurers from denying coverage for drugs
prescribed by their physician. The use of these drugs results in
lives being saved, less side effects, and shorter, less
expensive hospital stays. Supporters also say that similar
legislation has passed in 16 states.

Testifying for the bill were Representative Troupe; Association
of Community Cancer Centers; Missouri Society of Clinical
Oncology; and the American Cancer Society.

OPPONENTS:  There was no opposition voiced to the committee.

Ted Wedel, Research Analyst

HB 531 -- Insurance Coverage for Certain Drugs

Sponsor:  Troupe

The bill prohibits insurers and similar entities from denying
coverage of a drug based on the Food and Drug Administration's
(FDA's) non-approval for an illness, if the drug is recognized
as effective for treating the illness by the Department of
Insurance or in the United States Pharmacopeia Drug Information,
the American Medical Association Drug Evaluations, the American
Hospital Formulary Service Drug Information, or other medical
literature. Insurers and similar entities are not required to
cover experimental drugs that the FDA has not approved for any
use or drugs that the FDA has determined could be harmful.

In addition, the bill requires the Department of Insurance to
establish a 7-member panel to advise the department on whether a
drug should be covered. The panel is required to have 3
oncologists, 2 AIDS specialists, one heart disease specialist,
and one general practitioner.