Bill Text: IL SB1683 | 2009-2010 | 96th General Assembly | Engrossed

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Bill Title: Amends the State Employees Group Insurance Act of 1971, Illinois Insurance Code, and Health Maintenance Organization Act to set forth certain reference compendia and other authoritative compendia, as identified by the Federal Secretary of Health and Human Services or the insurance commissioner, in which a drug must be recognized for the treatment of the specific type of cancer for which the drug has been prescribed. Effective immediately.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2009-05-08 - Rule 19(a) / Re-referred to Rules Committee [SB1683 Detail]

Download: Illinois-2009-SB1683-Engrossed.html

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SB1683 Engrossed LRB096 09562 RPM 19723 b
AN ACT concerning insurance.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The State Employees Group Insurance Act of 1971
is amended by changing Section 6.4 as follows:
(5 ILCS 375/6.4) (from Ch. 127, par. 526.4)
Sec. 6.4. Prescription drugs; cancer treatment. If the
program of health benefits provides coverage for prescribed
drugs approved by the federal Food and Drug Administration for
the treatment of certain types of cancer, it may not 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 be recognized 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:
(a) the American Medical Association Drug Evaluations;
(a) (b) the American Hospital Formulary Service Drug
Information; or
(c) the United States Pharmacopeia Drug Information; or
(b) National Comprehensive Cancer Network's Drugs &

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Biologics Compendium;
(c) Thomson Micromedex's Drug Dex;
(d) Elsevier Gold Standard's Clinical Pharmacology; or
(e) other authoritative compendia as identified from
time to time by the federal Secretary of Health and Human
Services; or
if not in the compendia, recommended for that particular type
of cancer in formal clinical studies, the results of which have
been published in at least two peer reviewed professional
medical journals published in the United States or Great
Britain.
Any coverage required by this Section shall also include
those medically necessary services associated with the
administration of a drug.
Despite the provisions 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. This
Section shall apply only to cancer drugs. 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.
(Source: P.A. 87-980.)

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Section 10. The Illinois Insurance Code is amended by
changing Section 356z.7 as follows:
(215 ILCS 5/356z.7) (was 215 ILCS 5/370r)
Sec. 356z.7. Prescription drugs; cancer treatment. No
group policy of accident or health insurance 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 be recognized
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:
(a) the American Medical Association Drug Evaluations;
(a) (b) the American Hospital Formulary Service Drug
Information; or
(c) the United States Pharmacopeia Drug Information;
(b) National Comprehensive Cancer Network's Drugs &
Biologics Compendium;
(c) Thomson Micromedex's Drug Dex;
(d) Elsevier Gold Standard's Clinical Pharmacology; or
(e) other authoritative compendia as identified from
time to time by the federal Secretary of Health and Human

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Services;
or if not in the compendia, recommended for that particular
type of cancer in formal clinical studies, the results of which
have been published in at least two peer reviewed professional
medical journals published in the United States or Great
Britain.
Any coverage required by this Section shall also include
those medically necessary services associated with the
administration of a drug.
Despite the provisions 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. This
Section shall apply only to cancer drugs. 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.
(Source: P.A. 95-331, eff. 8-21-07.)
Section 15. The Health Maintenance Organization Act is
amended by changing Section 4-6.3 as follows:
(215 ILCS 125/4-6.3)
Sec. 4-6.3. Prescription drugs; cancer treatment. No

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health maintenance organization 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 be recognized 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: (a) the American Medical Association Drug
Evaluations; (b)
(a) the American Hospital Formulary Service Drug
Information; or (c) the United States Pharmacopeia Drug
Information;
(b) National Comprehensive Cancer Network's Drugs &
Biologics Compendium;
(c) Thomson Micromedex's Drug Dex;
(d) Elsevier Gold Standard's Clinical Pharmacology; or
(e) other authoritative compendia as identified from
time to time by the federal Secretary of Health and Human
Services;
or if not in the compendia, recommended for that particular
type of cancer in formal clinical studies, the results of which
have been published in at least two peer reviewed professional
medical journals published in the United States or Great

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Britain.
Any coverage required by this Section shall also include
those medically necessary services associated with the
administration of a drug.
Despite the provisions 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. This
Section shall apply only to cancer drugs. 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.
(Source: P.A. 87-980; 88-45.)
Section 99. Effective date. This Act takes effect upon
becoming law.