Texas § 1369.213 PROHIBITED CONDUCT.

Texas Statutes

§ 1369.213 — PROHIBITED CONDUCT.

Texas § 1369.213

Code INInsurance Code

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Bluebook

Tex. Insurance Code Code Ann. § 1369.213 (2026).

Text

Sec. 1369.213. PROHIBITED CONDUCT.

(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. SUBCHAPTER E-2. COVERAGE FOR CHIMERIC ANTIGEN RECEPTOR T-CE

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Sec. 1369.213. PROHIBITED CONDUCT. (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.
SUBCHAPTER E-2. COVERAGE FOR CHIMERIC ANTIGEN RECEPTOR T-CELL THERAPY