{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3407.5.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3407.5.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3407.5.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3407.5.html"}],"law_id":62057,"edition_id":1,"section_id":62057,"structure_id":12994,"section_number":"38.2-3407.5","catch_line":"Denial of benefits for certain prescription drugs prohibited","history":"1994, c. 374; 1997, c. 656; 2010, c. 443.","full_text":"A\n\nEach (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis, (ii) corporation providing individual or group accident and sickness subscription contracts, and (iii) health maintenance organization providing a health care plan for health care services, whose policy, contract or plan, including any certificate or evidence of coverage issued in connection with such policy, contract or plan, includes coverage for prescription drugs, whether on an inpatient basis, outpatient basis, or both, shall provide in each such policy, contract, plan, certificate, and evidence of coverage that such benefits will not be denied for any drug approved by the United States Food and Drug Administration for use in the treatment of cancer on the basis that the drug has not been approved by the United States Food and Drug Administration for the treatment of the specific type of cancer for which the drug has been prescribed, provided the drug has been recognized as safe and effective for treatment of that specific type of cancer in any of the standard reference compendia.B\n\nEach (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, (ii) corporation providing individual or group accident and sickness subscription contracts, and (iii) health maintenance organization providing a health care plan for health care services, whose policy, contract or plan, including any certificate or evidence of coverage issued in connection with such policy, contract or plan, includes coverage for prescription drugs, whether on an inpatient basis, outpatient basis, or both, shall provide in each such policy, contract, plan, certificate, and evidence of coverage that such benefits will not be denied for any drug prescribed to treat a covered indication so long as the drug has been approved by the United States Food and Drug Administration for at least one indication and the drug is recognized for treatment of the covered indication in one of the standard reference compendia or in substantially accepted peer-reviewed medical literature.C\n\nFor the purposes of subsections A and B:\n\t\t\t“Peer-reviewed medical literature” means a scientific study published only after having been critically reviewed for scientific accuracy, validity, and reliability by unbiased independent experts in a journal that has been determined by the International Committee of Medical Journal Editors to have met the Uniform Requirements for Manuscripts submitted to biomedical journals. Peer-reviewed medical literature does not include publications or supplements to publications that are sponsored to a significant extent by a pharmaceutical manufacturing company or health carrier.\n\t\t\t“Standard reference compendia” means:1\n\nAmerican Hospital Formulary Service Drug Information;2\n\nNational Comprehensive Cancer Network’s Drugs & Biologics Compendium; or3\n\nElsevier Gold Standard’s Clinical Pharmacology.D\n\nCoverage, as described in subsections A and B, includes medically necessary services associated with the administration of the drug.E\n\nSubsections A and B shall not be construed to do any of the following:1\n\nRequire coverage for any drug if the United States Food and Drug Administration has determined its use to be contraindicated for the treatment of the specific type of cancer or indication for which the drug has been prescribed;2\n\nRequire coverage for experimental drugs not otherwise approved for any indication by the United States Food and Drug Administration;3\n\nAlter any law with regard to provisions limiting the coverage of drugs that have not been approved by the United States Food and Drug Administration;4\n\nCreate, impair, alter, limit, modify, enlarge, abrogate, or prohibit reimbursement for drugs used in the treatment of any other disease or condition; or5\n\nRequire coverage for prescription drugs in any contract, policy or plan that does not otherwise provide such coverage.F\n\nThe provisions of this section shall not apply to short-term travel, or accident-only policies, or to short-term nonrenewable policies of not more than six months’ duration.G\n\nThe provisions of subsection A are applicable to contracts, policies or plans delivered, issued for delivery or renewed in this Commonwealth on and after July 1, 1994, and the provisions of subsection B are applicable to contracts, policies or plans delivered, issued for delivery or renewed in this Commonwealth on and after July 1, 1997.","order_by":null,"text":{"0":{"id":226455,"text":"Each (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense incurred basis, (ii) corporation providing individual or group accident and sickness subscription contracts, and (iii) health maintenance organization providing a health care plan for health care services, whose policy, contract or plan, including any certificate or evidence of coverage issued in connection with such policy, contract or plan, includes coverage for prescription drugs, whether on an inpatient basis, outpatient basis, or both, shall provide in each such policy, contract, plan, certificate, and evidence of coverage that such benefits will not be denied for any drug approved by the United States Food and Drug Administration for use in the treatment of cancer on the basis that the drug has not been approved by the United States Food and Drug Administration for the treatment of the specific type of cancer for which the drug has been prescribed, provided the drug has been recognized as safe and effective for treatment of that specific type of cancer in any of the standard reference compendia.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":226456,"text":"Each (i) insurer proposing to issue individual or group accident and sickness insurance policies providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, (ii) corporation providing individual or group accident and sickness subscription contracts, and (iii) health maintenance organization providing a health care plan for health care services, whose policy, contract or plan, including any certificate or evidence of coverage issued in connection with such policy, contract or plan, includes coverage for prescription drugs, whether on an inpatient basis, outpatient basis, or both, shall provide in each such policy, contract, plan, certificate, and evidence of coverage that such benefits will not be denied for any drug prescribed to treat a covered indication so long as the drug has been approved by the United States Food and Drug Administration for at least one indication and the drug is recognized for treatment of the covered indication in one of the standard reference compendia or in substantially accepted peer-reviewed medical literature.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":226457,"text":"For the purposes of subsections A and B:\n\t\t\t“Peer-reviewed medical literature” means a scientific study published only after having been critically reviewed for scientific accuracy, validity, and reliability by unbiased independent experts in a journal that has been determined by the International Committee of Medical Journal Editors to have met the Uniform Requirements for Manuscripts submitted to biomedical journals. Peer-reviewed medical literature does not include publications or supplements to publications that are sponsored to a significant extent by a pharmaceutical manufacturing company or health carrier.\n\t\t\t“Standard reference compendia” means:","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"C1"},"3":{"id":226458,"text":"American Hospital Formulary Service Drug Information;","type":"section","prefixes":["C","1"],"prefix":"1","entire_prefix":"C1","prefix_anchor":"C1","level":2,"prior_prefix":"C","next_prefix":"C2"},"4":{"id":226459,"text":"National Comprehensive Cancer Network’s Drugs & Biologics Compendium; or","type":"section","prefixes":["C","2"],"prefix":"2","entire_prefix":"C2","prefix_anchor":"C2","level":2,"prior_prefix":"C1","next_prefix":"C3"},"5":{"id":226460,"text":"Elsevier Gold Standard’s Clinical Pharmacology.","type":"section","prefixes":["C","3"],"prefix":"3","entire_prefix":"C3","prefix_anchor":"C3","level":2,"prior_prefix":"C2","next_prefix":"D"},"6":{"id":226461,"text":"Coverage, as described in subsections A and B, includes medically necessary services associated with the administration of the drug.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C3","next_prefix":"E"},"7":{"id":226462,"text":"Subsections A and B shall not be construed to do any of the following:","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D","next_prefix":"E1"},"8":{"id":226463,"text":"Require coverage for any drug if the United States Food and Drug Administration has determined its use to be contraindicated for the treatment of the specific type of cancer or indication for which the drug has been prescribed;","type":"section","prefixes":["E","1"],"prefix":"1","entire_prefix":"E1","prefix_anchor":"E1","level":2,"prior_prefix":"E","next_prefix":"E2"},"9":{"id":226464,"text":"Require coverage for experimental drugs not otherwise approved for any indication by the United States Food and Drug Administration;","type":"section","prefixes":["E","2"],"prefix":"2","entire_prefix":"E2","prefix_anchor":"E2","level":2,"prior_prefix":"E1","next_prefix":"E3"},"10":{"id":226465,"text":"Alter any law with regard to provisions limiting the coverage of drugs that have not been approved by the United States Food and Drug Administration;","type":"section","prefixes":["E","3"],"prefix":"3","entire_prefix":"E3","prefix_anchor":"E3","level":2,"prior_prefix":"E2","next_prefix":"E4"},"11":{"id":226466,"text":"Create, impair, alter, limit, modify, enlarge, abrogate, or prohibit reimbursement for drugs used in the treatment of any other disease or condition; or","type":"section","prefixes":["E","4"],"prefix":"4","entire_prefix":"E4","prefix_anchor":"E4","level":2,"prior_prefix":"E3","next_prefix":"E5"},"12":{"id":226467,"text":"Require coverage for prescription drugs in any contract, policy or plan that does not otherwise provide such coverage.","type":"section","prefixes":["E","5"],"prefix":"5","entire_prefix":"E5","prefix_anchor":"E5","level":2,"prior_prefix":"E4","next_prefix":"F"},"13":{"id":226468,"text":"The provisions of this section shall not apply to short-term travel, or accident-only policies, or to short-term nonrenewable policies of not more than six months’ duration.","type":"section","prefixes":["F"],"prefix":"F","entire_prefix":"F","prefix_anchor":"F","level":1,"prior_prefix":"E5","next_prefix":"G"},"14":{"id":226469,"text":"The provisions of subsection A are applicable to contracts, policies or plans delivered, issued for delivery or renewed in this Commonwealth on and after July 1, 1994, and the provisions of subsection B are applicable to contracts, policies or plans delivered, issued for delivery or renewed in this Commonwealth on and after July 1, 1997.","type":"section","prefixes":["G"],"prefix":"G","entire_prefix":"G","prefix_anchor":"G","level":1,"prior_prefix":"F"}},"ancestry":[{"id":12994,"edition_id":1,"name":"General Provisions","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214889,"object_type":"structure","relational_id":12994,"identifier":"1","token":"38.2\/34\/1","url":"\/38.2\/34\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214887,"object_type":"structure","relational_id":12993,"identifier":"34","token":"38.2\/34","url":"\/38.2\/34\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":57593,"structure_id":12994,"section_number":"38.2-3400","catch_line":"Application of chapter","url":"\/38.2-3400\/","token":"38.2\/34\/1\/38.2-3400","metadata":false},{"id":72072,"structure_id":12994,"section_number":"38.2-3401","catch_line":"Forms of insurance authorized","url":"\/38.2-3401\/","token":"38.2\/34\/1\/38.2-3401","metadata":false},{"id":65240,"structure_id":12994,"section_number":"38.2-3402","catch_line":"Certification to accompany application","url":"\/38.2-3402\/","token":"38.2\/34\/1\/38.2-3402","metadata":false},{"id":83988,"structure_id":12994,"section_number":"38.2-3403","catch_line":"Fraudulent procurement of policy","url":"\/38.2-3403\/","token":"38.2\/34\/1\/38.2-3403","metadata":false},{"id":65279,"structure_id":12994,"section_number":"38.2-3404","catch_line":"Commission may establish rules and regulations for simplified and readable accident and sickness insurance policies","url":"\/38.2-3404\/","token":"38.2\/34\/1\/38.2-3404","metadata":false},{"id":62539,"structure_id":12994,"section_number":"38.2-3405","catch_line":"Certain subrogation provisions and limitations upon recovery in hospital, medical, etc., policies forbidden; 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freedom of choice","url":"\/38.2-3407.7\/","token":"38.2\/34\/1\/38.2-3407.7","metadata":false},{"id":73400,"structure_id":12994,"section_number":"38.2-3407.8","catch_line":"Repealed","url":"\/38.2-3407.8\/","token":"38.2\/34\/1\/38.2-3407.8","metadata":false},{"id":72540,"structure_id":12994,"section_number":"38.2-3407.9","catch_line":"Reimbursement for emergency medical services vehicle transportation services","url":"\/38.2-3407.9\/","token":"38.2\/34\/1\/38.2-3407.9","metadata":false},{"id":62232,"structure_id":12994,"section_number":"38.2-3407.9:01","catch_line":"Prescription drug formularies","url":"\/38.2-3407.9_01\/","token":"38.2\/34\/1\/38.2-3407.9_01","metadata":false},{"id":62074,"structure_id":12994,"section_number":"38.2-3407.9:02","catch_line":"Requirement for prescription drug coverage","url":"\/38.2-3407.9_02\/","token":"38.2\/34\/1\/38.2-3407.9_02","metadata":false},{"id":68601,"structure_id":12994,"section_number":"38.2-3407.9:03","catch_line":"Payment of clean claims to administrators of pharmacy benefits","url":"\/38.2-3407.9_03\/","token":"38.2\/34\/1\/38.2-3407.9_03","metadata":false},{"id":56568,"structure_id":12994,"section_number":"38.2-3407.9:04","catch_line":"Medication synchronization","url":"\/38.2-3407.9_04\/","token":"38.2\/34\/1\/38.2-3407.9_04","metadata":false},{"id":71499,"structure_id":12994,"section_number":"38.2-3407.9:05","catch_line":"Step therapy protocols","url":"\/38.2-3407.9_05\/","token":"38.2\/34\/1\/38.2-3407.9_05","metadata":false}],"previous_section":{"id":57129,"structure_id":12994,"section_number":"38.2-3407.4:2","catch_line":"Requirements for prescription benefit cards","url":"\/38.2-3407.4_2\/","token":"38.2\/34\/1\/38.2-3407.4_2","metadata":false},"next_section":{"id":54072,"structure_id":12994,"section_number":"38.2-3407.5:1","catch_line":"Coverage for prescription contraceptives","url":"\/38.2-3407.5_1\/","token":"38.2\/34\/1\/38.2-3407.5_1","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3407.5\/","history_text":"

This law was first created in 1994. The record of its establishment is cataloged in chapter 374<\/a> of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. It has been modified 2 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1997, chapter 656<\/a>; in 2010, chapter 443<\/a>.<\/p>","references":[{"id":84333,"section_number":"38.2-3406.1","catch_line":"Application of requirements that policies offered by small employers include state-mandated health benefits","order_by":null,"url":"\/38.2-3406.1\/"},{"id":67952,"section_number":"38.2-4319","catch_line":"Statutory construction and relationship to other laws","order_by":null,"url":"\/38.2-4319\/"}],"refers_to":false,"permalink":{"id":215091,"object_type":"law","relational_id":62057,"identifier":"38.2-3407.5","token":"38.2\/34\/1\/38.2-3407.5","url":"\/38.2-3407.5\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3407.5\/","token":"38.2\/34\/1\/38.2-3407.5","dublin_core":{"Title":"Denial of benefits for certain prescription drugs prohibited","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3407.5","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> Each (i) insurer<\/span> proposing to issue<\/span> individual or group accident and sickness insurance policies<\/span> providing hospital, medical and surgical or major medical coverage on an expense incurred basis, (ii) corporation providing individual or group accident and sickness subscription contracts<\/span>, and (iii) health maintenance organization providing a health care plan for health care services, whose policy, contract<\/span> or plan, including any certificate or evidence<\/span> of coverage issued in connection with such policy, contract<\/span> or plan, includes coverage for prescription drugs, whether on an inpatient basis, outpatient basis, or both, shall provide in each such policy, contract<\/span>, plan, certificate, and evidence<\/span> of coverage that such benefits will not be denied for any drug approved by the United States<\/span> Food and Drug Administration for use in the treatment of cancer on the basis that the drug has not been approved by the United States<\/span> Food and Drug Administration for the treatment of the specific type of cancer for which the drug has been prescribed, provided the drug has been recognized as safe and effective for treatment of that specific type of cancer in any of the standard reference compendia. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Each (i) insurer<\/span> proposing to issue<\/span> individual or group accident and sickness insurance policies<\/span> providing hospital, medical and surgical or major medical coverage on an expense-incurred basis, (ii) corporation providing individual or group accident and sickness subscription contracts<\/span>, and (iii) health maintenance organization providing a health care plan for health care services, whose policy, contract<\/span> or plan, including any certificate or evidence<\/span> of coverage issued in connection with such policy, contract<\/span> or plan, includes coverage for prescription drugs, whether on an inpatient basis, outpatient basis, or both, shall provide in each such policy, contract<\/span>, plan, certificate, and evidence<\/span> of coverage that such benefits will not be denied for any drug prescribed to treat a covered indication so long as the drug has been approved by the United States<\/span> Food and Drug Administration for at least one indication and the drug is recognized for treatment of the covered indication in one of the standard reference compendia or in substantially accepted peer-reviewed medical literature<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> For the purposes of subsections A and B:\n\t\t\t“Peer-reviewed medical literature<\/span>” means a scientific study published only after having been critically reviewed for scientific accuracy, validity, and reliability by unbiased independent experts in a journal that has been determined by the International Committee of Medical Journal Editors to have met the Uniform Requirements for Manuscripts submitted to biomedical journals. Peer-reviewed medical literature<\/span> does not include publications or supplements to publications that are sponsored to a significant extent by a pharmaceutical manufacturing company<\/span> or health carrier.\n\t\t\t“Standard reference compendia” means: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> American Hospital Formulary Service Drug Information; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> National Comprehensive Cancer Network’s Drugs & Biologics Compendium; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Elsevier Gold Standard’s Clinical Pharmacology. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> Coverage, as described in subsections A and B, includes medically necessary services associated with the administration of the drug. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> Subsections A and B shall not be construed to do any of the following: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Require coverage for any drug if the United States<\/span> Food and Drug Administration has determined its use to be contraindicated for the treatment of the specific type of cancer or indication for which the drug has been prescribed; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Require coverage for experimental drugs not otherwise approved for any indication by the United States<\/span> Food and Drug Administration; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Alter any law<\/span> with regard to provisions limiting the coverage of drugs that have not been approved by the United States<\/span> Food and Drug Administration; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

4.<\/span> Create, impair, alter, limit, modify, enlarge, abrogate, or prohibit reimbursement for drugs used in the treatment of any other disease or condition; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

5.<\/span> Require coverage for prescription drugs in any contract<\/span>, policy or plan that does not otherwise provide such coverage. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

F.<\/span> The provisions of this section shall not apply to short-term travel, or accident-only policies, or to short-term nonrenewable policies of not more than six months’ duration. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

G.<\/span> The provisions of subsection A are applicable to contracts<\/span>, policies or plans delivered, issued for delivery or renewed in this Commonwealth on and after July 1, 1994, and the provisions of subsection B are applicable to contracts<\/span>, policies or plans delivered, issued for delivery or renewed in this Commonwealth on and after July 1, 1997. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nDENIAL OF BENEFITS FOR CERTAIN PRESCRIPTION DRUGS PROHIBITED (\u00a7 38.2-3407.5)\n\nA. Each (i) insurer proposing to issue individual or group accident and sickness\ninsurance policies providing hospital, medical and surgical or major medical\ncoverage on an expense incurred basis, (ii) corporation providing individual or\ngroup accident and sickness subscription contracts, and (iii) health maintenance\norganization providing a health care plan for health care services, whose\npolicy, contract or plan, including any certificate or evidence of coverage\nissued in connection with such policy, contract or plan, includes coverage for\nprescription drugs, whether on an inpatient basis, outpatient basis, or both,\nshall provide in each such policy, contract, plan, certificate, and evidence of\ncoverage that such benefits will not be denied for any drug approved by the\nUnited States Food and Drug Administration for use in the treatment of cancer on\nthe basis that the drug has not been approved by the United States Food and Drug\nAdministration for the treatment of the specific type of cancer for which the\ndrug has been prescribed, provided the drug has been recognized as safe and\neffective for treatment of that specific type of cancer in any of the standard\nreference compendia.\n\nB. Each (i) insurer proposing to issue individual or group accident and sickness\ninsurance policies providing hospital, medical and surgical or major medical\ncoverage on an expense-incurred basis, (ii) corporation providing individual or\ngroup accident and sickness subscription contracts, and (iii) health maintenance\norganization providing a health care plan for health care services, whose\npolicy, contract or plan, including any certificate or evidence of coverage\nissued in connection with such policy, contract or plan, includes coverage for\nprescription drugs, whether on an inpatient basis, outpatient basis, or both,\nshall provide in each such policy, contract, plan, certificate, and evidence of\ncoverage that such benefits will not be denied for any drug prescribed to treat\na covered indication so long as the drug has been approved by the United States\nFood and Drug Administration for at least one indication and the drug is\nrecognized for treatment of the covered indication in one of the standard\nreference compendia or in substantially accepted peer-reviewed medical\nliterature.\n\nC. For the purposes of subsections A and B:\n\t\t\t“Peer-reviewed medical literature” means a scientific study\npublished only after having been critically reviewed for scientific accuracy,\nvalidity, and reliability by unbiased independent experts in a journal that has\nbeen determined by the International Committee of Medical Journal Editors to\nhave met the Uniform Requirements for Manuscripts submitted to biomedical\njournals. Peer-reviewed medical literature does not include publications or\nsupplements to publications that are sponsored to a significant extent by a\npharmaceutical manufacturing company or health carrier.\n\t\t\t“Standard reference compendia” means:\n\n 1. American Hospital Formulary Service Drug Information;\n\n 2. National Comprehensive Cancer Network’s Drugs & Biologics\n Compendium; or\n\n 3. Elsevier Gold Standard’s Clinical Pharmacology.\n\nD. Coverage, as described in subsections A and B, includes medically necessary\nservices associated with the administration of the drug.\n\nE. Subsections A and B shall not be construed to do any of the following:\n\n 1. Require coverage for any drug if the United States Food and Drug\n Administration has determined its use to be contraindicated for the treatment\n of the specific type of cancer or indication for which the drug has been\n prescribed;\n\n 2. Require coverage for experimental drugs not otherwise approved for any\n indication by the United States Food and Drug Administration;\n\n 3. Alter any law with regard to provisions limiting the coverage of drugs that\n have not been approved by the United States Food and Drug Administration;\n\n 4. Create, impair, alter, limit, modify, enlarge, abrogate, or prohibit\n reimbursement for drugs used in the treatment of any other disease or\n condition; or\n\n 5. Require coverage for prescription drugs in any contract, policy or plan\n that does not otherwise provide such coverage.\n\nF. The provisions of this section shall not apply to short-term travel, or\naccident-only policies, or to short-term nonrenewable policies of not more than\nsix months’ duration.\n\nG. The provisions of subsection A are applicable to contracts, policies or plans\ndelivered, issued for delivery or renewed in this Commonwealth on and after July\n1, 1994, and the provisions of subsection B are applicable to contracts,\npolicies or plans delivered, issued for delivery or renewed in this Commonwealth\non and after July 1, 1997.\n\nHISTORY: 1994, c. 374; 1997, c. 656; 2010, c. 443.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}