RÉSUMÉ DIGEST
ACT 120 (HB 370) 2019 Regular Session Stokes
Prior law required any health coverage plan which included prescription benefits as part of
its policy or contract, which utilized step therapy or fail first protocols, and which was issued
for delivery, delivered, renewed, or otherwise contracted for in this state on or after Jan. 1,
2011, to comply with the provisions of prior law.
New law retains prior law but makes technical changes including the removal of a reference
to a repealed statute.
New 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.
New 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. Further provides that different salts
proven to have the same efficacy shall not be considered as different active ingredients.
New 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.
Existing law defines "health coverage plan".
New law clarifies that new law also applies to any health coverage plan which is
administered by a pharmacy benefit manager.
New law defines "stage-four advanced, metastatic cancer" as cancer that has spread from the
lymph nodes or other areas or parts of the body.
New 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 (June 5, 2019).
(Amends R.S. 22:1053(A) and (D); Adds R.S. 22:1053(E)-(G))