HB 11-1143 Summary

• Expands coverage for off-label prescription drug use beyond cancer treatment to include life-threatening diseases and chronic, seriously debilitating conditions.

• Requires health benefit plans to cover FDA-approved drugs prescribed for unapproved uses if the drug is recognized by American Hospital Formulary Service, is a recognized generic drug type, or receives A or B recommendations from the U.S. Preventive Services Task Force.

• For chronic and seriously debilitating conditions, the drug must be medically necessary and included on the health benefit plan formulary.

• Defines key terms including "life-threatening condition" (high likelihood of death without interruption of disease course), "chronic and seriously debilitating condition" (requires ongoing treatment with significant long-term morbidity), and "A Recommendation" and "B Recommendation" based on Task Force preventive health care service assessments.

• Takes effect July 1, 2011, and applies to health benefit plans issued or renewed on or after that date.