Subdivision 1. Definitions. (a) For purposes of this section, the following definitions apply.
(b) "Health plan" has the meaning given in section 62Q.01, subdivision 3. Health plan includes health coverage provided by a county-based purchasing plan participating in a public program under chapter 256B or 256L or an integrated health partnership under section 256B.0755.
(c) "Stage four advanced metastatic cancer" means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other parts of the body.
(d) "Step therapy protocol" has the meaning given in section 62Q.184, subdivision 1.
Subd. 2. Prohibition on use of step therapy protocols. A health plan that provides coverage for the treatment of stage four advanced metastatic cancer or associated conditions must not limit or exclude coverage for a drug approved by the United States Food and Drug Administration that is on the health plan's prescription drug formulary by mandating that an enrollee with stage four advanced metastatic cancer or associated conditions follow a step therapy protocol if the use of the approved drug is consistent with:
(1) a United States Food and Drug Administration-approved indication; and
(2) a clinical practice guideline published by the National Comprehensive Care Network.
History: 1Sp2019 c 9 art 8 s 13
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