RSA 415:6-g · Off-Label Prescription Drugs

415:6-g Off-Label Prescription Drugs. –

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I.

No insurer that issues or renews any individual policy of accident or health insurance providing benefits for medical or hospital expenses and providing coverage for prescription drugs shall:

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(a)

Exclude coverage for any such drug for a particular indication on the ground that the drug has not been approved by the Food and Drug Administration (FDA) for that indication, if such drug is recognized for treatment of such indication in one of the standard reference compendia or in the medical literature; or

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(b)

As a condition of coverage, impose use of an alternative drug not approved by the FDA for the indication being treated, unless such alternative drug is recognized for treatment of such indication in one of the standard reference compendia or in the medical literature. An override of such condition of coverage shall be expeditiously granted consistent with RSA 420-J:7-b, II whenever the prescriber can demonstrate that the alternative drug:

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(1)

Has been ineffective in the treatment of the insured's medical condition in the past;

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(2)

Is expected to be ineffective based on the known relevant physical or mental characteristics of the insured and the known characteristics of the drug regimen;

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(3)

Will cause or will likely cause an adverse reaction or other physical harm to the insured; or

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(4)

Is not in the insured's best interest, based on medical necessity consistent with RSA 420-J:7-b, II.

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II.

Any coverage of a drug required by this section shall also include medically necessary services associated with the administration of the drug.

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III.

Nothing in this section requires:

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(a)

Coverage for any drug if the FDA has determined its use to be contraindicated for the treatment of the particular indication for which the drug has been prescribed;

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(b)

Coverage for experimental or investigational drugs not approved for any indication by the FDA; and

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(c)

Reimbursement or coverage for any drug not included on the drug formulary or list of covered drugs specified in a health plan, contract, or policy. Source. 1999, 323:2. 2014, 226:1, eff. Sept. 12, 2014.

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