RÉSUMÉ DIGEST
ACT 222 (SB 204) 2020 Regular Session Talbot
Prior law required a health insurance issuer to provide coverage for the costs of
investigational treatments and associated protocol-related patient care if treatment is
provided or a study is conducted in a Phase II, Phase III, or Phase IV clinical trial for cancer.
New law retains prior law and extends coverage to a treatment provided or study conducted
in a Phase I clinical trial for cancer.
New law does not require a health insurance issuer to provide coverage for the following:
(1)Non-healthcare services provided as part of the clinical trial.
(2)Costs for managing research data associated with the clinical trial.
(3)Investigational drugs, devices, items, or services associated with the clinical trial.
New law prohibits a health coverage plan delivered or issued for delivery in this state from
denying coverage for the treatment of metastatic or unresectable tumors with a medically
necessary drug prescribed by a physician on the sole basis that the drug is not indicated for
the location in the body of the patient's cancer, if the drug is approved by the United States
Food and Drug Administration (FDA) for the treatment of the specific mutation of the
patient's cancer.
New law further provides that coverage may be denied if an alternative treatment has proven
to be more effective in published randomized clinical trials and is not contraindicated in the
patient.
New law requires any health coverage plan delivered or issued for delivery in this state to
include coverage for a minimum initial treatment period of at least three months for a
medically necessary drug prescribed by a physician that is not indicated for the location in
the body of the patient's cancer, if the drug is approved by the FDA for the treatment of the
specific mutation of the patient's cancer.
New law requires the health coverage plan to continue to provide coverage of the prescribed
drug after the initial treatment period if the treating physician certifies that the prescribed
drug is medically necessary for the treatment of the patient's cancer, based on documented
improvement of the patient.
Effective January 1, 2021.
(Amends R.S. 22:1044(E)(2); adds R.S. 22:1054.1)