(215 ILCS 125/4-6.3)
Sec. 4-6.3. Prescription drugs; cancer treatment. No health
maintenance organization that provides coverage for prescribed drugs
approved by the federal Food and Drug Administration for the treatment of
certain types of cancer shall exclude coverage of any drug on the basis
that the drug has been prescribed for the treatment of a type of cancer for
which the drug has not been approved by the federal Food and Drug
Administration. The drug, however, must be approved by the federal Food and
Drug Administration and must be recognized for the treatment of the
specific type of cancer for which the drug has been prescribed in any
one of the following established reference compendia:
(a) the American Hospital Formulary Service Drug Information; (b) National Comprehensive Cancer Network's Drugs & Biologics Compendium; (c) Thomson Micromedex's Drug Dex; (d) Elsevier Gold Standard's Clinical Pharmacology; or (e) other authoritative compendia as identified from time to time by the Federal | ||
| ||
or
if not in the compendia, recommended for that particular type of cancer
in formal clinical studies, the results of which have been published in at
least two peer reviewed professional medical journals published in the
United States or Great Britain.
Any coverage required by this Section shall also include those medically
necessary services associated with the administration of a drug.
Despite the provisions of this Section, coverage shall
not be required for any experimental or investigational drugs or any drug
that the federal Food and Drug Administration has determined to be
contraindicated for treatment of the specific type of cancer for which the
drug has been prescribed. This Section shall apply only to cancer drugs.
Nothing in this Section shall be construed, expressly or by implication, to
create, impair, alter, limit, notify, enlarge, abrogate or prohibit
reimbursement for drugs used in the treatment of any other disease or
condition.
(Source: P.A. 96-457, eff. 8-14-09.)
|