Indiana § 27-13-7-29.5 - Coverage for prescription drugs for advanced, metastatic cancer and associated conditions

§ 27-13-7-29.5. Coverage for prescription drugs for advanced, metastatic cancer and associated conditions

Sec. 29.5. (a) This section applies only to:

(1) a 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) an individual contract or a group contract that is entered into, 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 enrollee if left untreated.

(d) As used in this section, "group contract" refers to a group contract that provides coverage for prescription drugs.

(e) As used in this section, "health maintenance organization" refers to a health maintenance organization that provides coverage for prescription drugs. The term includes the following:

(1) A limited service health maintenance organization.

(2) A person that administers prescription drug benefits on behalf of a health maintenance organization or a limited service health maintenance organization.

(f) As used in this section, "individual contract" refers to an individual contract that provides coverage for prescription drugs.

(g) A health maintenance organization that provides coverage under an individual contract or a group contract for advanced, metastatic cancer and associated conditions may not require that, before the health maintenance organization provides coverage for a prescription drug, the enrollee:

(1) fail to successfully respond to a different prescription drug; or

(2) prove a history of failure of a different prescription drug.

As added by P.L.52-2026, SEC.3.

IC 27-13-8Chapter 8. Annual Report

27-13-8-0.1Application of certain amendments to chapter 27-13-8-1Filing 27-13-8-1.5Preparation of annual statement 27-13-8-2Filings with commissioner; complaint analysis and reporting 27-13-8-3Annual Statement Blank; quarterly reports 27-13-8-4Civil penalties