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SF 197

A bill for an act relating to insurance coverage for prescription drugs used in the treatment of metastatic cancer and associated conditions.

2025-2026 Regular Session Introduced by Annette Sweeney

Bill SF 197 ensures insurance covers prescription drugs for metastatic cancer without step therapy, improving access for patients starting January 1, 2026.

Subcommittee recommends passage.
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Bill Summary · SF 197

Summary of Bill SF 197

Title: A bill for an act relating to insurance coverage for prescription drugs used in the treatment of metastatic cancer and associated conditions.

Bill Number: SF 197
Introduced: February 04, 2025
Status: Subcommittee recommends passage
Classification: Bill
Subject Areas: Cancer, Health Insurance, Medical Care, Prescription Drugs, Therapy

Purpose and Intent

The primary purpose of Bill SF 197 is to ensure that insurance policies provide coverage for prescription drugs specifically used in the treatment of metastatic cancer and related conditions. The bill aims to eliminate barriers that patients may face when accessing necessary medications, particularly the use of step therapy protocols that can delay treatment.

Key Provisions

  1. Coverage Requirements:

    • Insurance policies must cover prescription cancer drugs without imposing a step therapy protocol if the following conditions are met:
      • The drug is used in accordance with established medical standards for metastatic cancer or associated conditions.
      • The drug's use is supported by peer-reviewed, evidence-based literature.
      • The drug has received approval from the United States Food and Drug Administration (FDA).

  2. Applicable Insurance Policies:

    • The bill applies to various classes of third-party payment provider contracts, policies, or plans that are:
      • Delivered, issued for delivery, continued, or renewed in the state on or after January 1, 2026.
      • Includes individual or group accident and sickness insurance, hospital or medical service contracts, health maintenance organization contracts, and plans for public employees.

  3. Exemptions:

    • The bill does not apply to certain types of insurance, including:
      • Accident-only, specified disease, short-term medical, dental, vision, Medicare supplement, long-term care, and other specific coverage types as defined by the commissioner of insurance.

  4. Rule Adoption:

    • The commissioner of insurance is authorized to adopt rules to administer the provisions of this bill.

Impact

  • Who is Affected:

    • Patients diagnosed with metastatic cancer and associated conditions will benefit from improved access to necessary prescription drugs.
    • Insurance providers will need to adjust their policies to comply with the new coverage requirements.
    • Healthcare providers will have clearer guidelines for prescribing treatments without the hindrance of step therapy protocols.

  • Timeline:

    • The bill is set to take effect for new or renewed insurance policies starting January 1, 2026.
    • The subcommittee has already recommended the bill for passage, indicating a positive reception in the legislative process.

Legislative Actions

  • February 04, 2025: Bill introduced and referred to the Commerce committee.
  • February 05, 2025: Subcommittee formed, consisting of members Sweeney, Koelker, and Petersen.
  • February 10, 2025: Subcommittee meeting scheduled for February 11, 2025, at 1:30 PM in the Senate Lounge.
  • February 11, 2025: Subcommittee recommends passage of the bill.

This summary provides an overview of Bill SF 197, highlighting its purpose, key provisions, and potential impact on patients and the healthcare system.

Compiled from official sources — confirm details with the bill’s official record.

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