500.3406e Coverage for drug used in antineoplastic therapy and cost of its administration; conditions.
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500.3406e Coverage for drug used in antineoplastic therapy and cost of its administration; conditions.
Sec. 3406e.
An insurer that delivers, issues for delivery, or renews in this state a health insurance policy shall provide coverage in each policy for a drug used in antineoplastic therapy and the reasonable cost of its administration. Coverage must be provided for any United States Food and Drug Administration approved drug regardless of whether the specific neoplasm for which the drug is being used as treatment is the specific neoplasm for which the drug has received approval by the United States Food and Drug Administration if all of the following conditions are met:
(a)The drug is ordered by a physician for the treatment of a specific type of neoplasm.
(b)The drug is approved by the United States Food and Drug Administration for use in antineoplastic therapy.
(c)The drug is used as part of an antineoplastic drug regimen.
(d)Current medical literature substantiates its efficacy and recognized oncology organizations generally accept the treatment.
(e)The physician has obtained informed consent from the patient for the treatment regimen that includes United States Food and Drug Administration approved drugs for off-label indications.
History: Add. 1989, Act 59, Imd. Eff. June 16, 1989 ;-- Am. 2016, Act 276 , Imd. Eff. July 1, 2016
Popular Name: Act 218