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| Public Act 096-0457 |
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AN ACT concerning insurance.
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Be it enacted by the People of the State of Illinois,
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represented in the General Assembly:
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Section 5. The State Employees Group Insurance Act of 1971 | ||||
is amended by changing Section 6.4 as follows:
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(5 ILCS 375/6.4) (from Ch. 127, par. 526.4)
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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
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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:
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(a) the American Medical Association Drug Evaluations;
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(a) (b) the American Hospital Formulary Service Drug | ||||
Information; or
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(c) the United States Pharmacopeia Drug Information; or
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(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 Secretary of Health and Human | ||
Services; 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.
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Any coverage required by this Section shall also include | ||
those medically
necessary services associated with the | ||
administration of a drug.
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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
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create, impair, alter, limit, notify, enlarge, abrogate or | ||
prohibit
reimbursement for drugs used in the treatment of any | ||
other disease or
condition.
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(Source: P.A. 87-980.)
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Section 10. The Illinois Insurance Code is amended by | ||
changing Section 356z.7 as follows:
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(215 ILCS 5/356z.7) (was 215 ILCS 5/370r)
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Sec. 356z.7. Prescription drugs; cancer treatment. No | ||
group policy of
accident or health insurance 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:
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(a) the American Medical Association Drug Evaluations;
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(a) (b) the American Hospital Formulary Service Drug | ||
Information; or
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(c) the United States Pharmacopeia Drug Information;
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(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 Secretary of Health and Human | ||
Services; | ||
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.
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Any coverage required by this Section shall also include | ||
those medically
necessary services associated with the | ||
administration of a drug.
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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
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create, impair, alter, limit, notify, enlarge, abrogate or | ||
prohibit
reimbursement for drugs used in the treatment of any | ||
other disease or
condition.
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(Source: P.A. 95-331, eff. 8-21-07.)
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Section 15. The Health Maintenance Organization Act is | ||
amended by changing Section 4-6.3 as follows:
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(215 ILCS 125/4-6.3)
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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
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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 Medical Association Drug | ||
Evaluations;
(b) | ||
(a) the American Hospital Formulary Service Drug | ||
Information; or
(c) the United States Pharmacopeia 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 Secretary of Health and Human | ||
Services; | ||
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.
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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.
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(Source: P.A. 87-980; 88-45.)
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Section 99. Effective date. This Act takes effect upon | ||
becoming law.
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