MI HB6250

Hospital, medical, and surgical insurance policies and HMO contracts providing pharmaceutical coverage must cover FDA-approved drugs used off-label, along with reasonable costs of supplies needed to administer them.

Off-label drug coverage applies only if the drug treats a life-threatening condition or chronic and seriously debilitating condition, is medically necessary, and is on or accessible through the plan formulary.

Drug must be recognized for the prescribed condition by specified sources including American Hospital Formulary Service, National Comprehensive Cancer Network, Thomson Micromedex Drugdex, or 2 articles from major peer-reviewed medical journals (with specific requirements for cancer treatment).

Prescribing physicians must provide documentation upon request to insurers or HMOs demonstrating compliance with coverage requirements.

Insurers may apply copayments, deductibles, prior approval, and drug utilization review programs to off-label prescriptions, but these cannot be more restrictive than coverage for standard prescription drugs.