Public Act 096-0457
Public Act 0457 96TH GENERAL ASSEMBLY
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Public Act 096-0457
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| HB2275 Enrolled |
LRB096 09560 RPM 19721 b |
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| AN ACT concerning insurance.
| Be it enacted by the People of the State of Illinois,
| represented in the General Assembly:
| Section 5. The State Employees Group Insurance Act of 1971 | is amended by changing Section 6.4 as follows:
| (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 Medical Association Drug Evaluations;
| (a) (b) the American Hospital Formulary Service Drug | Information; or
| (c) the United States Pharmacopeia Drug Information; or
| (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.
| 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. 87-980.)
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| Section 10. The Illinois Insurance Code is amended by | changing Section 356z.7 as follows:
| (215 ILCS 5/356z.7) (was 215 ILCS 5/370r)
| 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:
| (a) the American Medical Association Drug Evaluations;
| (a) (b) 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.
| 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. 95-331, eff. 8-21-07.)
| Section 15. The Health Maintenance Organization Act is | amended by changing Section 4-6.3 as follows:
| (215 ILCS 125/4-6.3)
| 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
| 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.
| 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. 87-980; 88-45.)
| Section 99. Effective date. This Act takes effect upon | becoming law.
|
Effective Date: 8/14/2009
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