RS 22:1054.1
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RS 22:1054.1
§1054.1. Requirement for coverage of cancer treatment targeting a specific genetic mutation
A. No health coverage plan delivered or issued for delivery in this state shall deny coverage for the treatment of metastatic or unresectable tumors or other advanced cancers with a medically necessary drug prescribed by a physician on the basis that the drug is not indicated for the specific tumor type or location in the body of the patient's cancer if the drug is approved by the United States Food and Drug Administration for the treatment of the specific mutation in a different type of cancer.
Insurers shall not consider the treatment experimental or outside of their policy scope if the United States Food and Drug Administration has approved the drug for the treatment of cancer with the specific genetic mutation, even if in a different tumor type. This coverage may be denied only if an alternative treatment has proven to be more effective in published randomized clinical trials and is not contraindicated in the patient.
B.(1) Any health coverage plan delivered or issued for delivery in this state shall include coverage for a minimum initial treatment period of not less than three months for a medically necessary drug prescribed by a physician that is not indicated for the location in the body of the patient's cancer if the drug is approved by the United States Food and Drug Administration for the treatment of the specific mutation of the patient's cancer.
(2)The health coverage plan shall continue to provide coverage of the prescribed drug after the initial treatment period provided for in Paragraph
(1)of this Subsection if the treating physician certifies that the prescribed drug is medically necessary for the treatment of the patient's cancer based on documented improvement of the patient.
C. For purposes of this Section, "health coverage plan" means any hospital, health, or medical expense insurance policy, hospital or medical service contract, employee welfare benefit plan, contract, or other agreement with a health maintenance organization or a preferred provider organization, health and accident insurance policy, or any other insurance contract of this type in this state, including a group insurance plan, a self-insurance plan, and the Office of Group Benefits programs.
"Health coverage plan" shall not include a plan providing coverage for excepted benefits as defined in R.S. 22:1061, limited benefit health insurance plans, and short-term policies that have a term of less than twelve months.
Acts 2020, No. 222, §1, eff. Jan. 1, 2021; Acts 2022, No. 299, §1.