HCR225

WHEREAS, cancer is a group of diseases characterized by uncontrolled growth and spread of abnormal cells; and

WHEREAS, cancer is the second leading cause of death in the State, with an average of 7,393 diagnoses of invasive cancer and 2,393 deaths annually; and

WHEREAS, many cancers can be cured if detected and treated promptly, and other forms of cancer can be prevented by lifestyle changes; and

WHEREAS, breast cancer remains the most frequently diagnosed cancer among women while prostate cancer remains the most frequently diagnosed cancer among men; and

WHEREAS, disparities in cancer incidence are significant among Native Hawaiians, who have the highest lung cancer incidence and mortality rates, and Filipino women, who have the highest incidence for thyroid cancer; and

WHEREAS, step therapy is a type of prior authorization that requires patients to try a certain, less expensive drug on a health insurance plan that has been proven effective before further treatments are authorized; and

WHEREAS, however, step therapy may limit full access to effective treatment options at early stages of illness; and

WHEREAS, section 23-51, Hawaii Revised Statutes, requires that "[b]efore any legislative measure that mandates health insurance coverage for specific health services, specific diseases, or certain providers of health care services as part of individual or group health insurance policies, can be considered, there shall be concurrent resolutions passed requesting the auditor to prepare and submit to the legislature a report that assesses both the social and financial effects of the proposed mandated coverage"; and

WHEREAS, section 23-51, Hawaii Revised Statutes, further provides that "[t]he concurrent resolutions shall designate a specific legislative bill that:

(1) Has been introduced in the legislature; and

(2) Includes, at a minimum, information identifying the:

(A) Specific health service, disease, or provider that would be covered;

(B) Extent of the coverage;

(D) Limitations on utilization, if any; and

(E) Standards of care.

For purposes of this part, mandated health insurance coverage shall not include mandated optionals."; and

WHEREAS, section 23-52, Hawaii Revised Statutes, further specifies the minimum information required for assessing the social and financial impact of the proposed health coverage mandate in the State Auditor's report; and

WHEREAS, Senate Bill No. 2316, introduced in the Regular Session of 2024, proposes to prohibit health insurers that cover treatment for stage two through stage five cancer from the requirement that an insured diagnosed with stage two through stage five cancer to undergo step therapy before covering the drug prescribed to the insured by the insured's health care provider, including:

(1) An investigational new drug; or

(2) A prescription drug:

(A) That is approved by the United States Food and Drug Administration;

(B) Whose use is consistent with best practices for the treatment of the cancer in its respective stage; and

WHEREAS, the Legislature believes that prohibiting health insurers that cover treatment for stage two through stage five cancer from requiring an insured diagnosed with stage two through stage five cancer to undergo step therapy before covering the drug prescribed to the insured by the insured's health care provider will increase the likelihood of proactive treatment of cancer and save lives; now, therefore,

BE IT RESOLVED by the House of Representatives of the Thirty-second Legislature of the State of Hawaii, Regular Session of 2024, the Senate concurring, that the Auditor is requested to conduct an impact assessment report in accordance with sections 23-51 and 23-52, Hawaii Revised Statutes, of prohibiting step therapy requirements in health insurance policies, contracts, plans, or agreements that cover the treatment of stage two through stage five cancer as proposed by Senate Bill No. 2316 (Regular Session of 2024); and

BE IT FURTHER RESOLVED that the Auditor is further requested to include in its assessment the impact of section 1311(d)(3) of the federal Patient Protection and Affordable Care Act (PPACA) on Senate Bill No. 2316, or similar legislation, that includes but is not limited to the additional cost of any benefits beyond the essential health benefits of Hawaii's qualified health plans under the PPACA; and

BE IT FURTHER RESOLVED that the Auditor is also requested to determine how many qualified health plans are available in Hawaii, including plans offered by health maintenance organizations; the individual or group enrollment in these plans; and the actuarial cost of the defrayment to the State for the prohibition of step therapy requirements for health plans that provide coverage of treatment of stage two through stage five cancer; and

BE IT FURTHER RESOLVED that the Auditor is requested to submit a report on the Auditor's findings and recommendations, including any proposed legislation, to the Legislature no later than twenty days prior to the convening of the Regular Session of 2025; and

BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Auditor and Insurance Commissioner, who is requested to transmit copies to each insurer in the State that issues health insurance policies.

	OFFERED BY:	_____________________________

Report Title:

Auditor; Impact Assessment Report; Mandatory Health Insurance Coverage; Step Therapy; Cancer

HOUSE OF REPRESENTATIVES	H.C.R. NO.	225
THIRTY-SECOND LEGISLATURE, 2024
STATE OF HAWAII