Prohibits health insurers from charging per-injection co-payments for specific drugs that control multiple sclerosis. (HB1356 HD1)

A BILL FOR AN ACT

SECTION 1. Multiple sclerosis (MS) is a chronic disease of the central nervous system involving loss of myelin in the brain and spinal cord. Myelin is a white, fatty, protective layer that insulates nerve fibers. MS causes an unpredictable, extremely varied pattern of myelin loss. Only part of a nerve loses its myelin sheath. The hole in the myelin sheath interrupts messages between the brain and the body. When a nerve impulse hits the uncovered area of the neuron, the bare spot breaks the flow of information along the nerve. At some point, the disease exceeds the body's inability to repair myelin and disability becomes permanent. The cause of MS is still unknown.

MS strikes one out of a thousand people in the U.S. MS is characterized by periods of illness followed by periods of remission. Some of the symptoms of MS include:

One of the most frustrating things about MS is that the long term course is so variable. One person may have one episode and remain symptom free for the rest of his life while another person may rapidly become wheelchair bound. Most neurologists subscribe to the "five year rule." This rule states that the most reliable predictor of someone's prognosis is how much disability and how many exacerbations they experience in the first five years after diagnosis.

The National Multiple Sclerosis Society (NMSS) has recently recommended the following three new injectible drugs to treat the underlying causes of MS rather than just its symptoms: Avonex, Betaseron, and Compaxone (collectively referred to as "ABC drugs"). According to NMSS, the ABC drugs can:

NMSS also recommends using the ABC drugs as soon as possible following a definite diagnosis of a relapsing course of MS.

The legislature finds that the ABC drugs are very expensive and many patients may not be able to afford to take advantage of these drugs. In Hawaii, patients with MS sometimes pay a cost of $5 to $10 per injection for the ABC drugs. The monthly cost for injections may exceed $320 per month. In other states, patients with MS are not charged per injection but on a per month basis. Charging patients on per month basis would make these drugs more affordable and accessible to everyone who needs it.

The purpose of this Act is to make drugs controlling MS more affordable by prohibiting health insurers from charging per-injection co-payments for these drugs.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

"§431:10A- Coverage for injectible drugs that control multiple sclerosis. (a) Notwithstanding any provision of law to the contrary, each employer group health policy, contract, plan, or agreement issued or renewed in this State on or after

(b) All policies, contracts, plans, or agreements under subsection (a), shall not impose any unusual copayment, charge, or waiting requirements for multiple sclerosis drugs."

SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to part VI to be appropriately designated and to read as follows:

"§432:- Coverage for injectible drugs that control multiple sclerosis. (a) Notwithstanding any provision of law to the contrary, each employer group health policy, contract, plan, or agreement issued or renewed in this State on or after

(b) All policies, contracts, plans, or agreements under subsection (a), shall not impose any unusual copayment, charge, or waiting requirements for multiple sclerosis drugs."

SECTION 4. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432D:- Coverage for injectible drugs that control multiple sclerosis. (a) Notwithstanding any provision of law to the contrary, each employer group health policy, contract, plan, or agreement issued or renewed in this State on or after

(b) All policies, contracts, plans, or agreements under subsection (a), shall not impose any unusual copayment, charge, or waiting requirements for multiple sclerosis drugs."

SECTION 5. New statutory material is underscored.

SECTION 6. This Act shall take effect upon its approval.