§ 627.4239 — Coverage for use of drugs in treatment of cancer

Florida § 627.4239

• Jurisdiction: Florida
• Title: XXXVII
• Ch. 627: INSURANCE RATES AND CONTRACTS

Text

(1) DEFINITIONS. — As used in this section, the term: (a) “Medical literature” means scientific studies published in a United States peer-reviewed national professional journal. (b) “Standard reference compendium” means authoritative compendia identified by the Secretary of the United States Department of Health and Human Services and recognized by the federal Centers for Medicare and Medicaid Services.

(2) COVERAGE FOR TREATMENT OF CANCER. — (a) An insurer may not exclude coverage in any individual or group insurance policy issued, amended, delivered, or renewed in this state which covers the treatment of cancer for any drug prescribed for the treatment of cancer on the ground that the drug is not approved by the United States Food and Drug Administration for a particular indication, if that drug is recognized for treatment of that indication in a standard reference compendium or recommended in the medical literature. (b) Coverage for a drug required by this section also includes the medically necessary services associated with the administration of the drug.

(3) APPLICABILITY AND SCOPE. — This section may not be construed to: (a) Alter any other law with regard to provisions limiting coverage for drugs that are not approved by the United States Food and Drug Administration. (b) Require coverage for any drug if the United States Food and Drug Administration has determined that the use of the drug is contraindicated. (c) Require coverage for a drug that is not otherwise approved for any indication by the United States Food and Drug Administration. (d) Affect the determination as to whether particular levels, dosages, or usage of a medication associated with bone marrow transplant procedures are covered under an individual or group health insurance policy or health maintenance organization contract. (e) Apply to specified disease or supplemental policies.

(4) Nothing in this section is intended, expressly or by implication, to create, impair, alter, limit, modify, enlarge, abrogate, prohibit, or withdraw any authority to provide reimbursement for drugs used in the treatment of any other disease or condition.

Legislative History

s. 1, ch. 95-268; s. 1, ch. 2009-202; s. 72, ch. 2009-223.