§ 58-65-94. Coverage of certain prescribed drugs for cancer treatment.

311 words·~1 min read·/nc/chapter-58/58-65-94

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(a)No insurance certificate or subscriber contract under any hospital service plan or medical service plan governed by this Article and Article 66 of this Chapter, and no preferred provider benefit plan under G.S. 58-50-56, that is issued, renewed, or amended on or after January 1, 1994, and 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 have been proven effective and accepted 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:

(1)The National Comprehensive Cancer Network Drugs & Biologics Compendium;

(2)The Micromedex DrugDex System;

(3)The Elsevier Gold Standard's Clinical Pharmacology; or

(4)Any other authoritative compendia as recognized periodically by the United States Secretary of Health and Human Services.

(b)Notwithstanding subsection

(a)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.

(c)This section shall apply only to cancer drugs and 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. (1993, c. 506, s. 4.2; 1997-519, s. 3.8; 2009-170, s. 2; 2023-133, s. 2(b).)