Texas Insurance Code 1369.213 – Prohibited Conduct
Current as of: 2024 | Check for updates
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(a) A health benefit plan that provides coverage for stage-four advanced, metastatic cancer and associated conditions may not require, before the health benefit plan provides coverage of a prescription drug approved by the United States Food and Drug Administration, that the enrollee:
(1) fail to successfully respond to a different drug; or
(2) prove a history of failure of a different drug.
(b) This section applies only to a drug the use of which is:
(1) consistent with best practices for the treatment of stage-four advanced, metastatic cancer or an associated condition;
(2) supported by peer-reviewed, evidence-based literature; and
(3) approved by the United States Food and Drug Administration.
Terms Used In Texas Insurance Code 1369.213
- United States: includes a department, bureau, or other agency of the United States of America. See Texas Government Code 311.005