DIGEST
The digest printed below was prepared by House Legislative Services. It constitutes no part of the
legislative instrument. The keyword, one-liner, abstract, and digest do not constitute part of the law
or proof or indicia of legislative intent. [R.S. 1:13(B) and 24:177(E)]
HB 370 Reengrossed 2019 Regular Session Stokes
Abstract: Prohibits a health insurer from using step therapy or fail first protocols as the basis to
restrict any prescription benefit for the treatment of a person with stage-four advanced,
metastatic cancer.
Present law requires any health coverage plan which includes prescription benefits as part of its
policy or contract, which utilizes step therapy or fail first protocols, and which is issued for delivery,
delivered, renewed, or otherwise contracted for in this state on or after Jan. 1, 2011, to comply with
the provisions of present law.
Proposed law retains present law but makes technical changes including the removal of a reference
to a repealed statute.
Proposed law prohibits a health coverage plan from using step therapy or fail first protocols as the
basis to restrict any prescription benefit for the treatment of stage-four advanced, metastatic cancer
or associated conditions if at least one of the following criteria is met:
(1)The prescribed drug or drug regimen has the U.S. Food and Drug Administration approved
indication.
(2)The prescribed drug or drug regimen has the National Comprehensive Cancer Network
Drugs and Biologics Compendium indication.
(3)The prescribed drug or drug regimen is supported by peer-reviewed, evidenced-based
medical literature.
Proposed law shall not apply if the health coverage plan's preferred drug or drug regimen is
considered clinically equivalent for therapy, contains the identical active ingredient or ingredients,
and is proven to have the same efficacy or is considered a higher ranked evidence-based option for
therapy as compared to the prescribed drug or drug regimen according to the National
Comprehensive Cancer Network Guidelines Categories of Evidence and Consensus or the Categories
of Preference. Further provides that different salts proven to have the same efficacy shall not be
considered as different active ingredients.
Proposed law requires the treating physician to inform the health coverage plan if a drug is
prescribed for a condition associated with stage-four advanced, metastatic cancer when requesting
authorization. Proposed law defines "stage-four advanced, metastatic cancer" as cancer that has spread from the
lymph nodes or other areas or parts of the body.
Proposed law defines "associated conditions" as the symptoms or side effects associated with
stage-four advanced, metastatic cancer or its treatment.
Effective upon signature of the governor or lapse of time for gubernatorial action.
(Amends R.S. 22:1053(A) and (D); Adds R.S. 22:1053(E)-(G))
Summary of Amendments Adopted by House
The Committee Amendments Proposed by House Committee on Insurance to the original bill:
1. Change the qualifying criteria for a prescribed drug.
2. Authorize a denial if the health coverage plan's preferred drug or drug regimen is
considered an equivalent or better option.
3. Require the treating physician to inform the health coverage plan if a drug is prescribed
for an associated condition.
4. Define associated condition.
5. Make technical changes.
The House Floor Amendments to the engrossed bill:
1. Narrow the exception to any drug that is considered clinically equivalent for therapy,
contains the identical active ingredient or ingredients, and is proven to have the same
efficacy or is considered a higher ranked evidence-based option.
2. Provide that different salts proven to have the same efficacy shall not be considered as
different active ingredients.