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HB 5204

Insurance: health insurers; prescription drug coverage for metastatic cancer; prohibit certain conditions. Amends 1956 PA 218 (MCL 500.100 - 500.8302) by adding sec. 3406rr.

2025-2026 Regular Session Introduced by Joey Andrews and 33 co-sponsors

Michigan bill restricts insurers from imposing coverage barriers on prescription drugs for metastatic cancer patients, aiming to ensure faster access to potentially life-saving treatments.

bill electronically reproduced 11/04/2025
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Bill Summary · HB 5204

Legislative bill overview

HB 5204 amends Michigan's insurance code to add Section 3406rr, which restricts health insurers' ability to impose certain conditions on prescription drug coverage for patients with metastatic cancer. The bill prohibits insurers from denying, limiting, or conditioning coverage for cancer medications based on specific criteria that the bill defines.

Why is this important

Metastatic cancer patients often require multiple medications and face barriers to accessing prescribed treatments due to insurance plan restrictions like prior authorization requirements or step therapy protocols. This legislation directly affects how cancer patients access potentially life-saving drugs by limiting insurers' ability to delay or deny coverage through administrative requirements.

Potential points of contention

  • Scope of prohibited conditions: The bill text doesn't specify which exact restrictions are banned, creating uncertainty about whether it addresses all coverage barriers (prior authorization, step therapy, formulary restrictions, etc.) or only some
  • Cost implications: Insurers may argue the mandate increases premiums by limiting their ability to manage drug utilization and costs; supporters counter that denying cancer medications shifts costs to patients in crisis
  • Medical necessity vs. coverage control: Disagreement exists over whether insurers should have authority to require clinical evidence before covering expensive medications, or whether oncologist recommendations should be presumptive

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

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