§ 27-55-2 - Prescription drug coverage. - Rhode Island Statutes

SECTION 27-55-2

   § 27-55-2  Prescription drug coverage.– (a) No health insurer issuing a policy which provides coverage for prescriptiondrugs shall exclude coverage of any drug used for the treatment of cancer onthe grounds that the drug has not been approved by the FDA for that indication,provided that the drug is recognized for treatment of that indication in one ofthe standard reference compendia, or in the medical literature. It is theresponsibility of the prescribing physician to submit to the insurerdocumentation supporting the proposed off-label use or uses, if requested bythe issuer.

   (b) Any coverage of a drug which serves as the primarytreatment required by this chapter shall also include medically necessaryservices associated with the administration of the drug.

   (c) No coverage is required under this chapter: (1) for anydrug which has not been fully licensed or approved by the FDA, (2) for the useof any drug when the FDA has determined that use to be contraindicated, or (3)for any experimental drug not approved for any indication by the FDA. Theprovisions of this section apply to drugs used in the treatment for cancer onlyand nothing in this section is construed to create, impair, alter, limit,modify, enlarge, abrogate or prohibit reimbursement for medications used in thetreatment of any other disease or condition.

   (d) Nothing in this section is construed to prevent theapplication of contractual deductibles or co-payment provisions or managed carereview.