(a)(1) In this section the following words have the meanings indicated.
(2) “Medical literature” means scientific studies published in a peer-reviewed national professional medical journal.
(3) “Off-label use” means the prescription of a drug for a treatment other than those treatments stated in the labeling approved by the federal Food and Drug Administration.
(4) “Standard reference compendia” means any authoritative compendia as recognized periodically by the federal Secretary of Health and Human Services or the Commissioner.
Drugs not approved by federal Food and Drug Administration
(b) This section does not:
(1) alter any law that limits the coverage of drugs that have not been approved by the federal Food and Drug Administration;
(2) require coverage of a drug if the federal Food and Drug Administration has determined use of the drug to be contraindicated; or
(3) require coverage of experimental drugs not approved for any indication by the federal Food and Drug Administration.
Coverage for off-label use of drugs
(c)(1) This subsection applies to each health insurance policy or contract that is delivered or issued for delivery in the State to an employer or individual on a group or individual basis, including a contract issued by a health maintenance organization.
(2) A policy or contract subject to this subsection that provides coverage for drugs may not exclude coverage of a drug for an off-label use of the drug if the drug is recognized for treatment in any of the standard reference compendia or in the medical literature.
(3) Coverage of a drug required by this subsection also includes medically necessary services associated with the administration of the drug.
Persons or health maintenance organizations directed to make payments
(d) The Commissioner may direct a person, including a health maintenance organization, that issues a health insurance policy or contract to make payments required by this section.
Credits
Added by Acts 1997, c. 35, § 2, eff. Oct. 1, 1997. Amended by Acts 2009, c. 112, § 1, eff. Oct. 1, 2009; Acts 2009, c. 113, § 1, eff. Oct. 1, 2009; Acts 2009, c. 656, § 1, eff. Oct. 1, 2009
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
