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H. B. No. 856 *HR26/R1903* ~ OFFICIAL ~ G1/2
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To: Public Health and Human
Services
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026
By: Representatives Felsher, Scott
HOUSE BILL NO. 856
AN ACT TO REENACT SECTION 83-9-8.1, MISSISSIPPI CODE OF 1972, 1
WHICH PROHIBITS A HEALTH BENEFIT PLAN FROM REQUIRING STEP THERAPY 2
OR FAIL-FIRST PROTOCOLS BEFORE THE PLAN PROVIDES COVERAGE OF 3
CERTAIN PRESCRIPTION DRUGS TO TREAT ADVANCED, METASTATIC CANCER 4
AND ASSOCIATED CONDITIONS; TO REENACT SECTION 83-9-36, MISSISSIPPI 5
CODE OF 1972, WHICH PRESCRIBES THE PROCESS BY WHICH A PRESCRIBING 6
PRACTITIONER MAY REQUEST AN OVERRIDE OF AN INSURER'S RESTRICTION 7
ON MEDICATION FOR USE BY A STEP THERAPY OR FAIL-FIRST PROTOCOL; TO 8
AMEND SECTION 3, CHAPTER 379, LAWS OF 2024, TO DELETE THE REPEALER 9
ON SECTIONS 83-9-8.1 AND 83-9-36, MISSISSIPPI CODE OF 1972; AND 10
FOR RELATED PURPOSES. 11
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 12
SECTION 1. Section 83-9-8.1, Mississippi Code of 1972, is 13
reenacted as follows: 14
83-9-8.1. (1) As used in this section, the following terms 15
shall be defined as provided in this subsection: 16
(a) "Associated conditions" means the symptoms or side 17
effects associated with advanced, metastatic cancer or its 18
treatment and which, in the judgment of the health care 19
practitioner, further jeopardizes the health of a patient if left 20
untreated. 21
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(b) "Advanced, metastatic cancer" means cancer that has 22
spread from the primary or original site of the cancer to nearby 23
tissues, lymph nodes, or other areas or parts of the body. 24
(c) "Health benefit plan" means a policy, contract, 25
certificate or agreement entered into, offered by or issued by an 26
insurer to provide, deliver, arrange for, pay for or reimburse any 27
of the costs of health care services. 28
(2) A health benefit plan that provides coverage for 29
advanced, metastatic cancer and associated conditions may not 30
require, before the health benefit plan provides coverage of a 31
prescription drug approved by the United States Food and Drug 32
Administration, that the enrollee: 33
(a) Fail to successfully respond to a different drug; 34
or 35
(b) Prove a history of failure of a different drug. 36
(3) This section applies only to a drug the use of which is: 37
(a) Consistent with best practices for the treatment of 38
advanced, metastatic cancer or an associated condition; 39
(b) Supported by peer-reviewed, evidence-based 40
literature; and 41
(c) Approved by the United States Food and Drug 42
Administration. 43
SECTION 2. Section 83-9-36, Mississippi Code of 1972, is 44
reenacted as follows: 45
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83-9-36. (1) When medications for the treatment of any 46
medical condition are restricted for use by an insurer by a step 47
therapy or fail-first protocol, the prescribing practitioner shall 48
have access to a clear and convenient process to expeditiously 49
request an override of that restriction from the insurer. An 50
override of that restriction shall be expeditiously granted by the 51
insurer under the following circumstances: 52
(a) The prescribing practitioner can demonstrate, based 53
on sound clinical evidence, that the preferred treatment required 54
under step therapy or fail-first protocol has been ineffective in 55
the treatment of the insured's disease or medical condition; or 56
(b) Based on sound clinical evidence or medical and 57
scientific evidence: 58
(i) The prescribing practitioner can demonstrate 59
that the preferred treatment required under the step therapy or 60
fail-first protocol is expected or likely to be ineffective based 61
on the known relevant physical or mental characteristics of the 62
insured and known characteristics of the drug regimen; or 63
(ii) The prescribing practitioner can demonstrate 64
that the preferred treatment required under the step therapy or 65
fail-first protocol will cause or will likely cause an adverse 66
reaction or other physical harm to the insured. 67
(2) The duration of any step therapy or fail-first protocol 68
shall not be longer than a period of thirty (30) days when the 69
treatment is deemed clinically ineffective by the prescribing 70
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practitioner. When the prescribing practitioner can demonstrate, 71
through sound clinical evidence, that the originally prescribed 72
medication is likely to require more than thirty (30) days to 73
provide any relief or an amelioration to the insured, the step 74
therapy or fail-first protocol may be extended up to seven (7) 75
additional days. 76
(3) As used in this section: 77
(a) "Insurer" means any hospital, health, or medical 78
expense insurance policy, hospital or medical service contract, 79
employee welfare benefit plan, contract or agreement with a health 80
maintenance organization or a preferred provider organization, 81
health and accident insurance policy, or any other insurance 82
contract of this type, including a group insurance plan. However, 83
the term "insurer" does not include a preferred provider 84
organization that is only a network of providers and does not 85
define health care benefits for the purpose of coverage under a 86
health care benefits plan. 87
(b) "Practitioner" has the same meaning as defined in 88
Section 73-21-73. 89
(4) The provisions of Section 83-9-8.1 shall supersede the 90
provisions of this section to the extent of any conflict between 91
Section 83-9-8.1 and this section. 92
SECTION 3. Section 3, Chapter 379, Laws of 2024, is amended 93
as follows: 94
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ST: Advanced, metastatic cancer; delete
repealer on prohibition against health plans
requiring step therapy before covering certain
drugs to treat.
Section 3. This act shall take effect and be in force from 95
and after July 1, 2024 * * *. 96
SECTION 4. This act shall take effect and be in force from 97
and after June 30, 2026. 98