GENERAL ASSEMBLY OF NORTH CAROLINA

SESSION 1993

S	1 

SENATE BILL 935

Short Title:  Health Coverage/Certain Drugs.	(Public)
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Sponsors: Senators Kaplan; and Ward.
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Referred to:  Insurance.
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April 21, 1993

A BILL TO BE ENTITLED
AN ACT TO REQUIRE THAT CERTAIN PRESCRIPTION DRUGS FOR CANCER TREATMENT BE COVERED UNDER HEALTH AND ACCIDENT INSURANCE POLICIES, IN HOSPITAL OR MEDICAL SERVICES PLANS, IN THE STATE EMPLOYEES' COMPREHENSIVE MAJOR MEDICAL PLAN, AND IN HMO PLANS.
The General Assembly of North Carolina enacts:
Section 1. Article 51 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-51-58. Coverage of certain prescribed drugs for cancer treatment.
(a)	No policy or contract of accident or health insurance, and no preferred provider contract, policy, or plan as defined and regulated under G.S. 58-50-50 and G.S. 58-50-55, 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 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:
(1)	The American Medical Association Drug Evaluations;
(2)	The American Hospital Formulary Service Drug Information; or
(3)	The United States Pharmacopeia Drug Information; or recommended by review article or editorial comment in a major peer-reviewed professional journal published in the United States.
(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."
Sec. 2. Article 54 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-54-11. Coverage of certain prescribed drugs for cancer treatment.
(a)	No policy 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 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:
(1)	The American Medical Association Drug Evaluations;
(2)	The American Hospital Formulary Service Drug Information; or
(3)	The United States Pharmacopeia Drug Information; or recommended by review article or editorial comment in a major peer-reviewed professional journal published in the United States.
(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."
Sec. 3. Article 65 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-65-93. Coverage of certain prescribed drugs for cancer treatment.
(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 contract, policy, or plan as defined and regulated under G.S. 58-50-50 and G.S. 58-50-55, 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 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:
(1)	The American Medical Association Drug Evaluations;
(2)	The American Hospital Formulary Service Drug Information; or
(3)	The United States Pharmacopeia Drug Information; or recommended by review article or editorial comment in a major peer-reviewed professional journal published in the United States.
(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."
Sec. 4. Article 67 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-67-77. Coverage of certain prescribed drugs for cancer treatment.
(a)	No health care plan written by a health maintenance organization and in force, 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 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:
(1)	The American Medical Association Drug Evaluations;
(2)	The American Hospital Formulary Service Drug Information; or
(3)	The United States Pharmacopeia Drug Information; or recommended by review article or editorial comment in a major peer-reviewed professional journal published in the United States.
(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."
Sec. 5. Article 50 of Chapter 58 of the General Statutes is amended by adding the following new section to read:
"§ 58-50-156. Coverage of certain prescribed drugs for cancer treatment.
(a)	Notwithstanding G.S. 58-50-125(c), if the standard health plan developed and approved under G.S. 58-50-125 provides coverage for prescribed drugs approved by the federal Food and Drug Administration for the treatment of certain types of cancer, then coverage may not be excluded for 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. Coverage for such drugs shall be as required under G.S. 58-51-58."
Sec. 6. Effective January 1, 1994, Chapter 135 of the General Statutes is amended by adding the following new section to read:
"§ 135-40.6B. Coverage of certain prescribed drugs for cancer treatment.
(a)	Coverage for prescription drugs approved by the federal Food and Drug Administration for the treatment of certain types of cancer shall include coverage of any drug prescribed for the treatment of a type of cancer notwithstanding that the drug has not been approved by the federal Food and Drug Administration for that type of cancer.  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:
(1)	The American Medical Association Drug Evaluations;
(2)	The American Hospital Formulary Service Drug Information; or
(3)	The United States Pharmacopeia Drug Information; or recommended by review article or editorial comment in a major peer-reviewed professional journal published in the United States.
(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."
Sec. 7. This act is effective upon ratification.