35 Pa. Stat. § 5704.103

Current through Pa Acts 2024-35, 2024-56

Section 5704.103 - Utilization management for stage four, advanced metastatic cancer drugs

A health insurance carrier or health insurance policy that, directly or indirectly, covers the treatment of stage four, advanced metastatic cancer 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 for this indication.

(2) The prescription of the drug is consistent with the best clinical practices for the treatment of stage four, advanced metastatic cancer or a severe adverse health condition experienced as a result of stage four, advanced metastatic cancer, and is supported by peer-reviewed medical literature.

35 P.S. § 5704.103

Added by P.L. TBD 2020 No. 6, § 3, eff. 4/12/2020.