(TRENTON) – Legislation sponsored by Assembly Democrats Herb Conaway, Jr. M.D., Valerie Vainieri Huttle and Ruben J. Ramos, Jr. requiring certain health insurance carriers to cover the off-label use of certain drugs was advanced Monday by an Assembly committee.
“The purpose of this bill is to extend the medical benefits that may derive from the use of off-label drugs to individuals who may not be able to access these medications, in particular those individuals who are suffering from a terminal or chronically debilitating illness, because their insurance carriers won’t cover these drugs,” said Conaway (D-Burlington).
The bill (A-1830) requires health benefits plans offered in the individual and small employer markets in New Jersey, which cover drugs that are approved by the federal Food and Drug Administration (FDA), the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP), to provide coverage for certain “off-label” uses of those drugs.
Off-label use refers to when a drug is prescribed for uses, periods of time, or at dosages that are not FDA-approved. Off-label drug use is legal when prescribed in a medically appropriate way.
“Medications can be quite expensive, especially when they must be taken routinely to treat a debilitating disease,” said Vainieri Huttle (D-Bergen). “If these drugs have proven effective in the treatment of a particular illness and deemed safe by a medical professional, then I don’t see why they should not be covered by these insurance companies. The health of the patient should come first.”
“Staying healthy in this country is costly. A person who is battling a serious illness should not have to worry about how they will afford a particular drug when they are paying for health insurance,” said Ramos (D-Hudson). “If the medication has been prescribed by a licensed physician and has proven beneficial to the patient, then the insurance company has a responsibility to cover it.”
The bill requires health insurance carriers that participate in the Individual Health Coverage Program, the Small Employer Health Benefits Program, the SHBP and the SEHBP to cover the off-label use of a drug, if the drug is recognized as being medically appropriate for the specific treatment for which it has been prescribed, in one of the two established reference compendia (the American Hospital Formulary Service Drug Information or the United States Pharmacopeia Drug Information), or is recommended by a clinical study or review article in a major peer-reviewed professional journal.
The bill was released by the Assembly Health and Senior Services Committee.