58-65-94. 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 benefit plan under G.S. 58-50-56, 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 have been proven effective and accepted 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 National Comprehensive Cancer Network Drugs & Biologics Compendium;
(2) The ThomsonMicromedex DrugDex;
(3) The Elsevier Gold Standard's Clinical Pharmacology; or
(4) Any other authoritative compendia as recognized periodically by the United States Secretary of Health and Human Services.
(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. (1993, c. 506, s. 4.2; 1997-519, s. 3.8; 2009-170, s. 2.)
Structure North Carolina General Statutes
North Carolina General Statutes
Article 65 - Hospital Service Corporations.
§ 58-65-1.1 - Definitions applicable to this Article.
§ 58-65-2 - Other laws applicable to all service corporations.
§ 58-65-5 - Contract for joint assumption or underwriting of risks.
§ 58-65-10 - Premium or dues paid.
§ 58-65-20 - Members of governing boards.
§ 58-65-25 - Hospital, physician, dentist, and optometrist contracts.
§ 58-65-30 - Dentists' services.
§ 58-65-35 - Nurses' services.
§ 58-65-36 - Physician services provided by physician assistants.
§ 58-65-50 - Application for certificate of authority or license.
§ 58-65-55 - Issuance and continuation of license.
§ 58-65-60 - Subscribers' contracts; required and prohibited provisions.
§ 58-65-65 - Coverage for active medical treatment in tax-supported institutions.
§ 58-65-70 - Contracts to cover any person possessing the sickle cell trait or hemoglobin C trait.
§ 58-65-75 - Coverage for chemical dependency treatment.
§ 58-65-80 - Meaning of terms "accident", "accidental injury", and "accidental means".
§ 58-65-85 - Discriminatory practices prohibited.
§ 58-65-90 - No discrimination against mentally ill or chemically dependent individuals.
§ 58-65-91 - Coverage for certain treatment of diabetes.
§ 58-65-92 - Coverage for mammograms and cervical cancer screening.
§ 58-65-93 - Coverage for prostate-specific antigen (PSA) tests.
§ 58-65-94 - Coverage of certain prescribed drugs for cancer treatment.
§ 58-65-95 - Investments and reserves.
§ 58-65-96 - Coverage for reconstructive breast surgery following mastectomy.
§ 58-65-100 - Statements filed with Commissioner.
§ 58-65-105 - Visitations and examinations.
§ 58-65-115 - Licensing and regulation of agents.
§ 58-65-125 - Revocation and suspension of license; unfair trade practices.
§ 58-65-130 - Amendments to certificate of incorporation.
§ 58-65-131 - Findings; definitions; conversion plan.
§ 58-65-132 - Review and approval of conversion plan; new corporation.
§ 58-65-133 - Creation and operation of foundation.
§ 58-65-135 - Cost plus plans.
§ 58-65-145 - Preexisting hospital service corporations.
§ 58-65-150 - Construction of Chapter as to single employer plans; associations exempt.
§ 58-65-155 - Merger or consolidation, proceedings for.
§ 58-65-166 - Policy statement and definitions.
§ 58-65-167 - Authority to indemnify.
§ 58-65-168 - Mandatory indemnification.
§ 58-65-169 - Advance for expenses.
§ 58-65-170 - Court-ordered indemnification.
§ 58-65-171 - Determination and authorization of indemnification.
§ 58-65-172 - Indemnification of officers, employees, and agents.