Coverage for certain cancer prescriptions., the official text

Second Regular Session of the 124th General Assembly (2026)

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  HOUSE ENROLLED ACT No. 1114

   AN ACT to amend the Indiana Code concerning insurance.

   Be it enacted by the General Assembly of the State of Indiana:

   SECTION 1. IC 5-10-8-18.5 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2026]: Sec. 18.5. (a) This section applies only to a:

      (1) prescription drug that is:
         (A) consistent with best practices for the treatment of
         advanced, metastatic cancer or an associated condition;
         (B) supported by peer reviewed, evidence based literature;
         and
         (C) approved by the federal Food and Drug
         Administration; and

      (2) state employee health plan that is established, entered into,
      amended, or renewed after June 30, 2026.
   (b) As used in this section, "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.
   (c) As used in this section, "associated conditions" means the
symptoms or side effects directly attributable to advanced,
metastatic cancer or its treatment, which based on the
recommendation of a health care practitioner and in accordance
with documented clinical evidence and generally accepted
guidelines, would further jeopardize the health of the covered

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individual if left untreated.
   (d) As used in this section, "covered individual" means an

individual entitled to coverage under a state employee health plan.
   (e) As used in this section, "state employee health plan" refers

to the following that provide coverage for prescription drugs:
      (1) A self-insurance program established under section 7(b) of
      this chapter.
      (2) A contract with a prepaid health care delivery plan that is
      entered into or renewed under section 7(c) of this chapter.

   (f) A state employee health plan that provides coverage for
advanced, metastatic cancer and associated conditions may not
require that, before the state employee health plan provides
coverage for a prescription drug, the covered individual:

      (1) fail to successfully respond to a different prescription
      drug; or
      (2) prove a history of failure of a different prescription drug.
   SECTION 2. IC 27-8-5-32 IS ADDED TO THE INDIANA CODE
AS A NEW SECTION TO READ AS FOLLOWS [EFFECTIVE JULY
1, 2026]: Sec. 32. (a) This section applies only to a:
      (1) prescription drug that is:

         (A) consistent with best practices for the treatment of
         advanced, metastatic cancer or an associated condition;
         (B) supported by peer reviewed, evidence based literature;
         and
         (C) approved by the federal Food and Drug
         Administration; and
      (2) policy of accident and sickness insurance that is issued,
      amended, or renewed after June 30, 2026.
   (b) As used in this section, "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.
   (c) As used in this section, "associated conditions" means the
symptoms or side effects directly attributable to advanced,
metastatic cancer or its treatment, which based on the
recommendation of a health care practitioner and in accordance
with documented clinical evidence and generally accepted
guidelines, would further jeopardize the health of the insured if left
untreated.
   (d) As used in this section, "insured" means an individual who
is entitled to coverage under a policy of accident and sickness
insurance.

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   (e) As used in this section, "policy of accident and sickness
insurance" means a policy of accident and sickness insurance that
provides coverage for prescription drugs.

   (f) A policy of accident and sickness insurance that provides
coverage for advanced, metastatic cancer and associated conditions
may not require that, before the policy of accident and sickness
insurance provides coverage for a prescription drug, the insured:

      (1) fail to successfully respond to a different prescription
      drug; or
      (2) prove a history of failure of a different prescription drug.
   SECTION 3. IC 27-13-7-29.5 IS ADDED TO THE INDIANA
CODE AS A NEW SECTION TO READ AS FOLLOWS
[EFFECTIVE JULY 1, 2026]: Sec. 29.5. (a) This section applies only
to:
      (1) a prescription drug that is:

         (A) consistent with best practices for the treatment of
         advanced, metastatic cancer or an associated condition;
         (B) supported by peer reviewed, evidence based literature;
         and
         (C) approved by the federal Food and Drug
         Administration; and
      (2) an individual contract or a group contract that is entered
      into, amended, or renewed after June 30, 2026.
   (b) As used in this section, "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.
   (c) As used in this section, "associated conditions" means the
symptoms or side effects directly attributable to advanced,
metastatic cancer or its treatment, which based on the
recommendation of a health care practitioner and in accordance
with documented clinical evidence and generally accepted
guidelines, would further jeopardize the health of the enrollee if
left untreated.
   (d) As used in this section, "group contract" refers to a group
contract that provides coverage for prescription drugs.
   (e) As used in this section, "health maintenance organization"
refers to a health maintenance organization that provides coverage
for prescription drugs. The term includes the following:
      (1) A limited service health maintenance organization.
      (2) A person that administers prescription drug benefits on
      behalf of a health maintenance organization or a limited

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      service health maintenance organization.
   (f) As used in this section, "individual contract" refers to an
individual contract that provides coverage for prescription drugs.
   (g) A health maintenance organization that provides coverage
under an individual contract or a group contract for advanced,
metastatic cancer and associated conditions may not require that,
before the health maintenance organization provides coverage for
a prescription drug, the enrollee:

      (1) fail to successfully respond to a different prescription
      drug; or
      (2) prove a history of failure of a different prescription drug.

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Speaker of the House of Representatives

President of the Senate

President Pro Tempore

Governor of the State of Indiana

Date:                             Time:

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