An Act Regarding
Maine Legislature, Session 132, LD 0178
Committee Amendment CA_A_H272 (House)
Amends: 24-A MRSA §4320-N

COMMITTEE AMENDMENT "A" to H.P. 111, L.D. 178, "An Act Regarding 
Coverage for Step Therapy for Advanced Metastatic Cancer" 
Amend the bill by striking out the title and substituting the following: 
'An Act Regarding Coverage for Step Therapy for Metastatic Cancer' 
Amend the bill by striking out everything after the enacting clause and inse1ting the 
following: 
'Sec. 1. 24-A MRSA §4320-N, sub-§1, ,IA-1 is enacted to read: 
A-1. 
11Associated conditions
means the symptoms or side effects associated with 
metastatic cancer or its treatment and that, in the judgment of the health care 
practitioner. further jeopardize the health of a patient if left untreated. 
Sec. 2. 24-A MRSA §4320-N, sub-§1, ,IC-1 is enacted to read: 
C-1. 
11Metastatic cancer" means cancer that has spread from the primary or original 
site of the cancer to nearby tissues, lymph nodes or other areas or parts of the body. 
Sec. 3. 24-A MRSA §4320-N, sub-§8 is enacted to read: 
•• 
8. 
Step therapy for metastatic cancer and~ associated conditions proni6Hed.~~~ 
• 
Notwithstanding subsection 6, paragraph B, with respect to coverage of a prescription drug 
on a carrier's formulary for the treatment of metastatic cancer and associated conditions, a 
canier or utilization review organization may not require that the enrollee use a step therapy 
protocol before the carrier provides coverage of a prescription drug approved by the United 
States Food and Drug Administration. 
Sec. 4. 
Appropriations and allocations. The following appropriations and 
allocations are made. 
ADMINISTRATIVE AND FINANCIAL SERVICES, DEPARTMENT OF 
Departments and Agencies - Statewide 0016 
COMMITTEE AMENDMENT 
ROS 
COMMITTEEAMENDMENT'A" to H.P. 111, L.D. 178 
Initiative: Provides funding to allow enrollees to use step therapy protocols before the 
carrier provides coverage of prescription drugs approved by the United States Food and 
Drug Administration. The expanded requirements apply to health plans issued or renewed 
on or after January 1, 2026. 
GENERAL FUND 
All Other 
GENERAL FUND TOTAL 
HIGHWAY FUND 
All Other 
HIGHWAY FUND TOTAL 
2025-26 
$0 
$0 
2025-26 
$0 
$0 
2026-27 
$7,176 
$7,176, 
2026-27 
$2,496 
$2,496 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or section 
ti umber to read consecutively. 
SUMMARY 
This amendment replaces the bill and changes the title. With respect to coverage of a 
prescription drug on a carrier's formulary for the treatment of metastatic cancer and 
associated conditions, the amendment prohibits a health insurance carrier or utilization 
review organization from requiring an enrollee to use a step therapy protocol before the 
carrier provides coverage of a prescription drug approved by the United States Food and 
Drug Administration. The amendment also adds an appropriations and allocations section. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 05/21/25 LRL 
LD 178 
LR 578(02) 
An Act Regarding Coverage for Step Therapy for Advanced Metastatic Cancer 
Fiscal Note for Bill as Amended by Committee Amendment ':A / !-\-212) 
Committee: Health Coverage, Insurance and Financial Services LI 
Net Cost (Savings) 
General Fund 
Highway Fund 
Appropriations/Allocations 
General Fund 
Highway Fund 
Fiscal Detail and Notes 
Fiscal Note Required: Yes 
Fiscal Note 
FY 2025-26 
$0 
$0 
$0 
$0 
FY 2026-27 
$7,176 
$2,496 
$7,176 
$2,496 
Projections 
FY 2027-28 
$7,176, 
$2,496 
$7,176 
$2,496 
Projections 
FY 2028-29 
$7,176 
$2,496 
$7,176 
$2,496 
This bill prohibits health insurance carriers and utilization review organizations from requiring enrollees to use step 
therapy protocols before the carrier provides coverage of prescription drugs approved by the United States Food and 
Drug Administration with respect to coverage of prescription drugs on the carrier's formulary for the treatment of 
metastatic cancer and associated conditions. 
The requirements of the bill apply to health plans issued or renewed on or after January 1, 2026. The State Employee 
Health Plan's first impacted plan year will be fiscal year 2026-27 and is estimated to cost $15,600 annually thereafter. 
The costs are split across the General Fund ($7,176), Highway Fund ($2,496), and all other funds ($5,928). 
LR0578(02) - Fiscal Note - Page 1 of 1