tissues, lymph nodes or other areas or parts of the body.
Section 3. Utilization management for stage four, advanced
metastatic cancer drugs.
A health insurance carrier or health insurance plan POLICY
that, directly or indirectly, covers the treatment of stage
four, advanced metastatic cancer shall MAY not require an
enrollee to first fail to successfully respond to a different
drug, or prove a history of failure in use of a different drug,
before providing coverage for a COVERED drug TO WHICH BOTH OF
THE FOLLOWING APPLY:
(1) THE DRUG IS approved by the United States Food and
Drug Administration; and
(2) the use of which is consistent THE DRUG IS
CONSISTENT WITH ITS FDA-APPROVED INDICATION AND with the best
CLINICAL practices for the treatment of stage four, advanced
metastatic cancer.
Section 4. Applicability.
This act shall apply to insurance plans issued, delivered or
renewed on or after the effective date of this section. AS
FOLLOWS:
(1) FOR A HEALTH INSURANCE POLICY FOR WHICH EITHER RATES
OR FORMS ARE REQUIRED TO BE FILED WITH THE FEDERAL GOVERNMENT
OR THE INSURANCE DEPARTMENT, THIS ACT SHALL APPLY TO ANY
POLICY FOR WHICH A RATE OR FORM IS FIRST FILED ON OR AFTER
180 DAYS AFTER THE EFFECTIVE DATE OF THIS ACT.
(2) FOR A HEALTH INSURANCE POLICY FOR WHICH NEITHER
RATES NOR FORMS ARE REQUIRED TO BE FILED WITH THE FEDERAL
GOVERNMENT OR THE INSURANCE DEPARTMENT, THIS ACT SHALL APPLY
TO ANY POLICY ISSUED OR RENEWED ON OR AFTER 180 DAYS AFTER
THE EFFECTIVE DATE OF THIS ACT.
20190SB0066PN0926 - 3 -
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