Prohibited Conduct

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. SUBCHAPTER E-2. COVERAGE FOR CHIMERIC ANTIGEN RECEPTOR T-CELL THERAPY