RÉSUMÉ DIGEST
ACT 299 (SB 146) 2022 Regular Session Talbot
Prior law prohibited a health coverage plan from denying coverage for the treatment of
metastatic or unresectable tumors with a medically necessary drug prescribed by a physician
on the 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 U.S. Food and Drug Administration (FDA) for the treatment
of the specific mutation of the patient's cancer. Provides that coverage may be denied if an
alternative treatment has proven to be more effective in published randomized clinical trials
and such treatment is not contraindicated in the patient. New law retains the prior law
prohibition but applies it to the treatment of other advanced cancers.
New law prohibits denial of coverage on the basis that the medically necessary drug is not
indicated for a specific tumor type. Further prohibits an insurer from considering the
treatment as experimental or outside of its policy scope if the FDA has approved the drug
for the treatment of cancer with the specific genetic mutation, even if the treatment is for a
different type of tumor.
Effective August 1, 2022.
(Amends R.S. 22:1054.1(A))