(1) No insurance policy or contract providing coverage for a prescription drug to a resident of this state shall exclude coverage of that drug for a particular indication solely on the grounds that the indication has not been approved by the United States Food and Drug Administration if the Health Evidence Review Commission established under ORS 414.688 (Commission established) or the Pharmacy and Therapeutics Committee established under ORS 414.353 (Committee established) determines that the drug is recognized as effective for the treatment of that indication:
(a) In publications that the commission or the committee determines to be equivalent to:
(A) The American Hospital Formulary Service drug information;
(B) Drug Facts and Comparisons (Lippincott-Raven Publishers);
(C) The United States Pharmacopoeia drug information; or
(D) Other publications that have been identified by the United States Secretary of Health and Human Services as authoritative;
(b) In the majority of relevant peer-reviewed medical literature; or
(c) By the United States Secretary of Health and Human Services.
(2) Required coverage of a prescription drug under this section shall include coverage for medically necessary services associated with the administration of that drug.
(3) Nothing in this section requires coverage for any prescription drug if the United States Food and Drug Administration has determined use of the drug to be contraindicated.
(4) Nothing in this section requires coverage for experimental drugs not approved for any indication by the United States Food and Drug Administration.
(5) This section is exempt from ORS 743A.001 (Automatic repeal of certain statutes on individual and group health insurance). [Formerly 743.697; 2011 c.720 §222]
3 OregonLaws.org assembles these lists by analyzing references between Sections. Each listed item refers back to the current Section in its own text. The result reveals relationships in the code that may not have otherwise been apparent.