What does the Michigan law say about coverage for chemotherapy (antineoplastic) drugs?
Michigan law requires health insurance companies, Blue Cross Blue Shield of Michigan and HMOs to pay for FDA approved drugs used in antineoplastic therapy (chemotherapy) and the reasonable cost to administer them. When the FDA approves a drug to be used in chemotherapy, it does so for the treatment of a specific type of cancer. Since the drug is FDA approved, it can be used for the treatment of other types of cancer. This is known as an “off label” use of a drug. The FDA will not review or approve these multiple uses for drugs. There have been problems with third party payers denying payment for “off label” chemotherapy drugs. Michigan law provides that an antineoplastic (chemotherapy) drug is covered if it is FDA approved, the current medical literature substantiates its efficacy to treat the type of cancer and the patient is informed that the treatment is an “off label” use.
