TITLE 27

Insurance

CHAPTER 27-55

Off-label Uses of Prescription Drugs

SECTION 27-55-2



   § 27-55-2  Prescription drug coverage.

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(a) No health insurer issuing a policy which provides coverage for prescription

drugs shall exclude coverage of any drug used for the treatment of cancer on

the grounds that the drug has not been approved by the FDA for that indication,

provided that the drug is recognized for treatment of that indication in one of

the standard reference compendia, or in the medical literature. It is the

responsibility of the prescribing physician to submit to the insurer

documentation supporting the proposed off-label use or uses, if requested by

the issuer.



   (b) Any coverage of a drug which serves as the primary

treatment required by this chapter shall also include medically necessary

services associated with the administration of the drug.



   (c) No coverage is required under this chapter: (1) for any

drug which has not been fully licensed or approved by the FDA, (2) for the use

of any drug when the FDA has determined that use to be contraindicated, or (3)

for any experimental drug not approved for any indication by the FDA. The

provisions of this section apply to drugs used in the treatment for cancer only

and nothing in this section is construed to create, impair, alter, limit,

modify, enlarge, abrogate or prohibit reimbursement for medications used in the

treatment of any other disease or condition.



   (d) Nothing in this section is construed to prevent the

application of contractual deductibles or co-payment provisions or managed care

review.



History of Section.

(P.L. 1994, ch. 339, § 1.)