Delaware Code Title 18 Sec. 3566 – Prescription medication
(a) This section applies to every group or blanket policy or contract of health insurance, including each policy or contract issued by a health service corporation, which is delivered or issued for delivery in this State and which provides coverage for outpatient prescription drugs.
Terms Used In Delaware Code Title 18 Sec. 3566
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- State: means the State of Delaware; and when applied to different parts of the United States, it includes the District of Columbia and the several territories and possessions of the United States. See Delaware Code Title 1 Sec. 302
(b) Every group or blanket policy or contract of health insurance described in subsection (a) of this section shall provide coverage for any outpatient drug prescribed to treat a covered person for a covered chronic, disabling or life-threatening illness if the drug:
(1) Has been approved by the Food and Drug administration for at least 1 indication; and
(2) Is recognized for treatment of the indication for which the drug is prescribed in:
a. A prescription drug reference compendium approved by the Insurance Commissioner for purposes of this section; or
b. Substantially accepted peer reviewed medical literature.
(c) Coverage of a drug required by this section shall include coverage of medically necessary services associated with administration of the drug.
(d) This section does not require coverage for:
(1) Medication that may be obtained without a physician’s prescription;
(2) Experimental drugs not otherwise approved for the proposed use or indication by the Food and Drug Administration; or
(3) Any disease, condition, service or treatment that is excluded from coverage under the policy.
(e) Nothing in this section shall prevent the operation of policy provisions involving deductibles, coinsurance, allowable charge limitations, maximum dollar policy limitations or coordination of benefits.