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(5 ILCS 375/6.4) (from Ch. 127, par. 526.4)
Sec. 6.4. Prescription drugs; cancer treatment. If the program of
health benefits provides coverage for prescribed drugs approved by the
federal Food and Drug Administration for the treatment of certain types of
cancer, it may not 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 |
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(b) National Comprehensive Cancer Network's Drugs &
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(c) Thomson Micromedex's Drug Dex;
(d) Elsevier Gold Standard's Clinical Pharmacology; or
(e) other authoritative compendia as identified from
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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.)
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