Indiana health plans cannot require drug failure for some cancer drugs

A state employee health plan may not require a covered person to fail another drug, or prove a past failure, before covering the qualifying prescription drug. This covers people entitled to prescription drug coverage under the state employee health plan types named in the law. The rule applies when the plan covers advanced, metastatic cancer and associated conditions. The drug must follow treatment best practices, have support from peer-reviewed, evidence-based literature, and be approved by the FDA. Associated conditions are symptoms or side effects of the cancer or its treatment that could further harm the person's health if untreated. The law takes effect July 1, 2026, and applies to plans established, entered into, changed, or renewed after June 30, 2026.

An accident and sickness insurer may not require an insured person to fail another drug, or prove a past failure, before covering the qualifying prescription drug. This covers people insured under accident and sickness policies that provide prescription drug coverage. The rule applies when the policy covers advanced, metastatic cancer and associated conditions. The drug must follow treatment best practices, have support from peer-reviewed, evidence-based literature, and be approved by the FDA. Associated conditions are symptoms or side effects of the cancer or its treatment that could further harm the person's health if untreated. The law takes effect July 1, 2026, and applies to policies issued, changed, or renewed after June 30, 2026.

A health maintenance organization may not require an enrollee to fail another drug, or prove a past failure, before covering the qualifying prescription drug. This covers people enrolled in individual or group contracts with health maintenance organizations that provide prescription drug coverage, including limited-service organizations and benefit administrators acting for them. The rule applies when the contract covers advanced, metastatic cancer and associated conditions. The drug must follow treatment best practices, have support from peer-reviewed, evidence-based literature, and be approved by the FDA. Associated conditions are symptoms or side effects of the cancer or its treatment that could further harm the person's health if untreated. The law takes effect July 1, 2026, and applies to individual or group contracts entered into, changed, or renewed after June 30, 2026.