Sec. 1369.213. PROHIBITED CONDUCT. (a) A health benefit plan that provides coverage for stage-four advanced, metastatic cancer and associated conditions may not require, before the health benefit plan provides coverage of a prescription drug approved by the United States Food and Drug Administration, that the enrollee:
(1) fail to successfully respond to a different drug; or
(2) prove a history of failure of a different drug.
(b) This section applies only to a drug the use of which is:
(1) consistent with best practices for the treatment of stage-four advanced, metastatic cancer or an associated condition;
(2) supported by peer-reviewed, evidence-based literature; and
(3) approved by the United States Food and Drug Administration.
Added by Acts 2019, 86th Leg., R.S., Ch. 1350 (H.B. 1584), Sec. 1, eff. September 1, 2019.
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