Coverage for prescription drugs for advanced, metastatic cancer and associated conditions

Sec. 32. (a) This section applies only to a: (1) prescription drug that is: (A) consistent with best practices for the treatment of advanced, metastatic cancer or an associated condition; (B) supported by peer reviewed, evidence based literature; and (C) approved by the federal Food and Drug Administration; and (2) policy of accident and sickness insurance that is issued, amended, or renewed after June 30, 2026. (b) As used in this section, "advanced, metastatic 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. (c) As used in this section, "associated conditions" means the symptoms or side effects directly attributable to advanced, metastatic cancer or its treatment, which based on the recommendation of a health care practitioner and in accordance with documented clinical evidence and generally accepted guidelines, would further jeopardize the health of the insured if left untreated. (d) As used in this section, "insured" means an individual who is entitled to coverage under a policy of accident and sickness insurance. (e) As used in this section, "policy of accident and sickness insurance" means a policy of accident and sickness insurance that provides coverage for prescription drugs. (f) A policy of accident and sickness insurance that provides coverage for advanced, metastatic cancer and associated conditions may not require that, before the policy of accident and sickness insurance provides coverage for a prescription drug, the insured: (1) fail to successfully respond to a different prescription drug; or (2) prove a history of failure of a different prescription drug.