Mandated Health Benefits – Drugs for Stage Four Advanced, Metastatic Cancer

On April 27, 2016, Georgia Governor Nathan Deal signed legislation regarding mandated health coverage for stage four metastatic cancer. 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 areas or parts of the body.

Pursuant to the law, no health benefit plan issued, delivered, or renewed in Georgia that, as a provision of hospital, medical, or surgical services, directly or indirectly covers the treatment of stage four advanced, metastatic cancer may limit or exclude coverage for a drug approved by the U.S. Food and Drug Administration (FDA) by mandating that the insured first be required to fail to successfully respond to a different drug or drugs or prove a history of failure of such drug or drugs. This is provided that the use of such drug or drugs is consistent with best practices for the treatment of stage four advanced, metastatic cancer and is supported by peer reviewed medical literature.

The law goes into effect on July 1, 2016.

Read GA H.B. 965