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H. B. No. 944 *HR26/R449* ~ OFFICIAL ~ G1/2
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To: Public Health and Human
Services
MISSISSIPPI LEGISLATURE REGULAR SESSION 2026
By: Representative Shanks
HOUSE BILL NO. 944
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 REENACTED SECTIONS 83-9-8.1 AND 83-9-36, MISSISSIPPI CODE OF 9
1972, TO CODIFY AND EXTEND THE DATE OF THE REPEALER ON THOSE 10
SECTIONS WHICH WAS ORIGINALLY ENACTED IN THE EFFECTIVE DATE 11
SECTION OF THE ENABLING LEGISLATION; TO AMEND SECTION 3, CHAPTER 12
379, LAWS OF 2024, TO DELETE THE REPEALER ON SECTIONS 83-9-8.1 AND 13
83-9-36, MISSISSIPPI CODE OF 1972, FROM THE EFFECTIVE DATE SECTION 14
OF THAT ACT; AND FOR RELATED PURPOSES. 15
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI: 16
SECTION 1. Section 83-9-8.1, Mississippi Code of 1972, is 17
reenacted and amended as follows: 18
83-9-8.1. (1) As used in this section, the following terms 19
shall be defined as provided in this subsection: 20
(a) "Associated conditions" means the symptoms or side 21
effects associated with advanced, metastatic cancer or its 22
treatment and which, in the judgment of the health care 23
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practitioner, further jeopardizes the health of a patient if left 24
untreated. 25
(b) "Advanced, metastatic cancer" means cancer that has 26
spread from the primary or original site of the cancer to nearby 27
tissues, lymph nodes, or other areas or parts of the body. 28
(c) "Health benefit plan" means a policy, contract, 29
certificate or agreement entered into, offered by or issued by an 30
insurer to provide, deliver, arrange for, pay for or reimburse any 31
of the costs of health care services. 32
(2) A health benefit plan that provides coverage for 33
advanced, metastatic cancer and associated conditions may not 34
require, before the health benefit plan provides coverage of a 35
prescription drug approved by the United States Food and Drug 36
Administration, that the enrollee: 37
(a) Fail to successfully respond to a different drug; 38
or 39
(b) Prove a history of failure of a different drug. 40
(3) This section applies only to a drug the use of which is: 41
(a) Consistent with best practices for the treatment of 42
advanced, metastatic cancer or an associated condition; 43
(b) Supported by peer-reviewed, evidence-based 44
literature; and 45
(c) Approved by the United States Food and Drug 46
Administration. 47
(4) This section shall stand repealed on July 1, 2029. 48
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SECTION 2. Section 83-9-36, Mississippi Code of 1972, is 49
reenacted and amended as follows: 50
83-9-36. (1) When medications for the treatment of any 51
medical condition are restricted for use by an insurer by a step 52
therapy or fail-first protocol, the prescribing practitioner shall 53
have access to a clear and convenient process to expeditiously 54
request an override of that restriction from the insurer. An 55
override of that restriction shall be expeditiously granted by the 56
insurer under the following circumstances: 57
(a) The prescribing practitioner can demonstrate, based 58
on sound clinical evidence, that the preferred treatment required 59
under step therapy or fail-first protocol has been ineffective in 60
the treatment of the insured's disease or medical condition; or 61
(b) Based on sound clinical evidence or medical and 62
scientific evidence: 63
(i) The prescribing practitioner can demonstrate 64
that the preferred treatment required under the step therapy or 65
fail-first protocol is expected or likely to be ineffective based 66
on the known relevant physical or mental characteristics of the 67
insured and known characteristics of the drug regimen; or 68
(ii) The prescribing practitioner can demonstrate 69
that the preferred treatment required under the step therapy or 70
fail-first protocol will cause or will likely cause an adverse 71
reaction or other physical harm to the insured. 72
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(2) The duration of any step therapy or fail-first protocol 73
shall not be longer than a period of thirty (30) days when the 74
treatment is deemed clinically ineffective by the prescribing 75
practitioner. When the prescribing practitioner can demonstrate, 76
through sound clinical evidence, that the originally prescribed 77
medication is likely to require more than thirty (30) days to 78
provide any relief or an amelioration to the insured, the step 79
therapy or fail-first protocol may be extended up to seven (7) 80
additional days. 81
(3) As used in this section: 82
(a) "Insurer" means any hospital, health, or medical 83
expense insurance policy, hospital or medical service contract, 84
employee welfare benefit plan, contract or agreement with a health 85
maintenance organization or a preferred provider organization, 86
health and accident insurance policy, or any other insurance 87
contract of this type, including a group insurance plan. However, 88
the term "insurer" does not include a preferred provider 89
organization that is only a network of providers and does not 90
define health care benefits for the purpose of coverage under a 91
health care benefits plan. 92
(b) "Practitioner" has the same meaning as defined in 93
Section 73-21-73. 94
(4) The provisions of Section 83-9-8.1 shall supersede the 95
provisions of this section to the extent of any conflict between 96
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ST: Advanced, metastatic cancer; extend and
codify repealer on prohibition against health
plans requiring step therapy before covering
certain drugs to treat.
Section 83-9-8.1 and this section. This subsection shall stand 97
repealed on July 1, 2029. 98
SECTION 3. Section 3, Chapter 379, Laws of 2024, is amended 99
as follows: 100
Section 3. This act shall take effect and be in force from 101
and after July 1, 2024 * * *. 102
SECTION 4. This act shall take effect and be in force from 103
and after June 30, 2026. 104