advanced metastatic cancer and associated conditions without proving step therapy. A. A health benefit plan that provides coverage for 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. Fails to successfully respond to a different drug; or 2. Proves 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 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.
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