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HLS 26RS-1078 RE-REENGROSSED
2026 Regular Session
HOUSE BILL NO. 766
BY REPRESENTATIVE FREEMAN
INSURANCE/HEALTH: Provides relative to coverage for orally administered anti-cancer
medications
1 AN ACT
2 To amend and reenact R.S. 22:999.1, relative to health insurance coverage; to establish
3 guidelines for the coverage of orally administered anti-cancer medications; to ensure
4 parity between orally administered and intravenously administered or injected anti-
5 cancer medications; to impose prohibitions on cost-sharing, utilization management,
6 and copayment adjustment programs; to provide for definitions; to provide for
7 applicability; and to provide for related matters.
8 Be it enacted by the Legislature of Louisiana:
9 Section 1. R.S. 22:999.1 is hereby amended and reenacted to read as follows:
10 §999.1. Parity for orally administered anti-cancer medications with intravenously
11 administered or injected anti-cancer medications
12 A. It is hereby declared that the public policy of this state is that every
13 person within this state with a health insurance coverage plan that provides coverage
14 for cancer treatment shall have access to the type of covered medication used to treat
15 his the insured's cancer, as such a decision affects the person's overall, long-term
16 health and quality of life. It is also declared that orally administered anti-cancer
17 medications, although very effective in killing or slowing the growth of cancerous
18 cells, have high out-of-pocket costs to the covered person, impacting the decision of
19 physicians to prescribe such medications, thus restricting patient access to life-saving
20 oral anti-cancer medications. It is further declared that physicians must be able to
21 make the best choice for their patients, considering the unique aspects of each patient
22 and the progress of the disease.
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1 B.(1) A health insurance issuer that provides coverage for cancer treatment
2 shall provide for coverage of for prescribed orally administered anti-cancer
3 medications on a basis no less favorable than intravenously administered or injected
4 anti-cancer medications, as provided in this Section.
5 (2) Health insurance coverage of orally administered anti-cancer medications
6 shall not be subject to any prior authorization, dollar limit, copayment, deductible,
7 or other out-of-pocket expense that does not apply to intravenously administered or
8 injected cancer medications, regardless of formulation or benefit category
9 determination by the health insurance issuer. A health coverage plan shall not
10 impose any prior authorization, dollar limit, copayment, deductible, coinsurance,
11 specialty tier placement, formulary classification, benefit category determination, or
12 other cost-sharing or utilization management requirement on orally administered
13 anti-cancer medications that results in greater out-of-pocket expense or more
14 restrictive access than that imposed on intravenously administered or injected anti-
15 cancer medications by the health insurance issuer.
16 (3) Cost-sharing for orally administered anti-cancer medications shall be
17 applied toward the enrollee's deductible and annual out-of-pocket maximum in the
18 same manner as other covered benefits under the health coverage plan.
19 (4) A health insurance issuer shall not reclassify or increase any type of cost-
20 sharing to the covered person for anti-cancer medications in order to achieve
21 compliance with this Section. Any change in health insurance coverage that
22 otherwise increases an out-of-pocket expense applied to anti-cancer medications
23 shall also be applied to the majority of comparable medical or pharmaceutical
24 benefits covered by the health insurance issuer.
25 (4)(5) A health insurance issuer that limits the total amount paid by a covered
26 person through all cost-sharing requirements to no more than one hundred dollars per
27 filled prescription for any orally administered anti-cancer medication shall be
28 considered in compliance with this Section. For purposes of this
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HLS 26RS-1078 RE-REENGROSSED
HB NO. 766
1 Paragraph,"cost-sharing requirements" shall include copayments, coinsurance,
2 deductibles, and any other amounts paid by the covered person for that prescription.
3 (6) A health coverage plan shall not impose any prior authorization, dollar
4 limit, copayment, deductible, coinsurance, specialty tier placement, formulary
5 classification, benefit category determination, or other cost-sharing or utilization
6 management requirement on orally administered anti-cancer medications that results
7 in greater out-of-pocket expense or more restrictive access than that imposed on
8 intravenously administered or injected anti-cancer medications by the health
9 insurance issuer. This provision applies to high-deductible health plan policies that
10 are eligible for use in conjunction with Health Savings Accounts (HSAs), Medical
11 Savings Accounts (MSAs), or other similar programs authorized under 26 U.S.C. §
12 220 et seq.
13 C. As used in this Section:
14 (1) "Anti-cancer medications" means medications used to kill or slow the
15 growth of cancer cells, including orally administered, self-administered, injected, or
16 intravenously administered medications approved for the treatment of cancer.
17 (2) "Covered person" means a policyholder, subscriber, enrollee, or other
18 individual enrolled in or insured by a health insurance issuer for a health insurance
19 coverage plan.
20 (3) "Health insurance coverage plan" or "coverage" means benefits
21 consisting of medical care provided or arranged for directly, through insurance or
22 reimbursement, or through a network, and including services paid for as medical care
23 under any hospital or medical service policy or certificate, hospital or medical
24 service plan contract, preferred provider organization agreement, or health
25 maintenance organization contract offered by a health insurance issuer, including
26 individual and group policies and plans.
27 (4) "Health insurance issuer" means any entity that offers a health insurance
28 coverage plan through a policy or certificate of insurance subject to state law that
29 regulates the business of insurance. For purposes of this Section, a "health insurance
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1 issuer" shall include a health maintenance organization, as defined and licensed
2 pursuant to Subpart I of Part I of Chapter 2 of this Title, nonfederal government
3 plans subject to the provisions of Subpart B of this Part, and the Office of Group
4 Benefits.
5 (5) "Network of providers" or "network" means an entity other than a health
6 insurance issuer that, through contracts with health care providers, provides or
7 arranges for access by groups of covered persons to covered health care services by
8 health care providers who are not otherwise or individually contracted directly with
9 a health insurance issuer.
10 (6) "Copayment adjustment program" means a benefit design, practice, or
11 program implemented by a health insurance issuer or pharmacy benefit manager that
12 adjusts, reduces, excludes, or otherwise fails to credit the value of any manufacturer-
13 sponsored or third-party payment, discount, voucher, coupon, or financial assistance
14 toward an enrollee's deductible, cost-sharing obligation, or annual out-of-pocket
15 maximum under the health coverage plan.
16 (7) "Specialty tier" means a formulary tier within a health coverage plan that
17 imposes a coinsurance percentage or other cost-sharing requirement that exceeds the
18 lowest applicable cost-sharing tier for prescription drugs under the health coverage
19 plan.
20 D. The provisions of this Section shall not apply to the following:
21 (1) Limited benefit health insurance policies or contracts.
22 (2) High deductible health plans or policies that are qualified to be used in
23 conjunction with a health savings account, a medical savings account, or other
24 similar program authorized by 26 U.S.C. 220 et seq.
25 (3) Qualified health plans offered through a health benefit exchange.
26 (1) This Section shall apply to individual and group health coverage plans,
27 high-deductible health plans, qualified health plans offered through a health benefit
28 exchange, nonfederal governmental plans, and the Office of Group Benefits, to the
29 maximum extent permitted under federal law.
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HB NO. 766
1 (2) The provisions of this Section do not apply to limited benefit health
2 insurance policies or contracts.
3 (3) Nothing in this Section shall be construed to regulate self-funded
4 employee benefit plans governed by the Employee Retirement Income Security Act
5 of 1974 (ERISA), except to the extent permitted under federal law.
DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part
of the legislative instrument. The keyword, one-liner, abstract, and digest do not constitute
part of the law or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 766 Re-Reengrossed 2026 Regular Session Freeman
Abstract: Establishes updated requirements governing health insurance coverage for orally
administered anti-cancer medications.
Present law requires health insurance issuers that provide coverage for cancer treatment to
provide coverage for orally administered anti-cancer medications on a basis no less favorable
than intravenously administered or injected cancer medications.
Present law prohibits certain cost-sharing practices, authorizes a $100 per-prescription cap
for compliance, and excludes high-deductible health plans, limited benefit policies, and
qualified health plans offered through a health benefit exchange from applicability.
Proposed law expands oral chemotherapy parity requirements:
(1) Requires coverage of prescribed orally administered anti-cancer medications on a
basis no less favorable than intravenously administered or injected anti-cancer
medications.
(2) Prohibits prior authorization, dollar limits, copayments, deductibles, coinsurance,
specialty tier placement, formulary classification, benefit category determinations,
or other cost-sharing or utilization management requirements that result in greater
out-of-pocket expense or more restrictive access for orally administered anti-cancer
medications.
(3) Requires cost-sharing for orally administered anti-cancer medications to be applied
toward the enrollee’s deductible and annual out-of-pocket maximum in the same
manner as other covered benefits.
(4) Prohibits a health insurance issuer from reclassifying or increasing cost-sharing for
anti-cancer medications to achieve compliance.
(5) Prohibits copayment adjustment programs, including accumulator and maximizer
programs, that fail to credit manufacturer or third-party financial assistance toward
an enrollee’s deductible, cost-sharing obligation, or annual out-of-pocket maximum
for certain high-deductible plan policies.
(6) Defines "anti-cancer medications", "copayment adjustment program", "covered
person", "health coverage plan", "health insurance issuer", "network of providers",
and "specialty tier".
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(7) Applies proposed law to individual and group health coverage plans, high-deductible
health plans, qualified health plans offered through a health benefit exchange,
nonfederal governmental plans, and the Office of Group Benefits, to the maximum
extent permitted pursuant to federal law.
(8) Revises applicability provisions to clarify that the proposed law does not apply to
limited benefit health insurance policies or contracts.
(9) Clarifies that nothing in the proposed law will be construed to regulate self-funded
employee benefit plans governed by the Employee Retirement Income Security Act
of 1974 (ERISA), except to the extent permitted pursuant to federal law.
(Amends R.S. 22:999.1)
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the
original bill:
1. Clarify the scope of applicability by specifying that it does not apply to
limited-benefit health insurance policies or contracts.
2. Establish an exemption for self-funded employee benefit plans governed by the
Employee Retirement Income Security Act of 1974 (ERISA). It stipulates that
proposed law shall not be interpreted as regulating these plans, except to the
extent permitted by federal law.
3. Make technical changes.
The Committee Amendments Proposed by House Committee on Appropriations to the
engrossed bill:
1. Reinstate present law regarding cost-sharing requirements.
2. Limit application of proposed law regarding copayment adjustment programs to
certain high-deductible plans.
The House Floor Amendments to the reengrossed bill:
1. Establish access to oral chemotherapy framework that recognizes issuers as
compliant when they limit patient cost-sharing to a maximum of $100 per
prescription.
2. Prohibit prior authorization and other cost-sharing or utilization management
practices that impose higher out-of-pocket expenses or restrict access to orally
administered anti-cancer medications compared to intravenously administered
or injected therapies.
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