Section 415:18-j Off-Label Prescription Drugs.
I. No insurer that issues or renews any policy of group or blanket accident or health insurance providing benefits for medical or hospital expenses and providing coverage for prescription drugs shall exclude coverage for any such drug for a particular indication on the ground that the drug has not been approved by the Food and Drug Administration (FDA) for that indication, if such drug is recognized for treatment of such indication in one of the standard reference compendia or in the medical literature as recommended by current American Medical Association (AMA) policies.
II. Any coverage of a drug required by this section shall also include medically necessary services associated with the administration of the drug.
III. Nothing in this section requires:
(a) Coverage for any drug if the FDA has determined its use to be contraindicated for the treatment of the particular indication for which the drug has been prescribed;
(b) Coverage for experimental or investigational drugs not approved for any indication by the FDA; and
(c) Reimbursement or coverage for any drug not included on the drug formulary or list of covered drugs specified in a health plan, contract, or policy.
Source. 1999, 323:6, eff. Sept. 14, 1999.