S-0628.1                   _______________________________________________

                                                     SENATE BILL 5458

                              _______________________________________________

State of Washington                              53rd Legislature                             1993 Regular Session

By Senators Wojahn and Sheldon

Read first time 01/29/93.  Referred to Committee on Health & Human Services.

Regulating insurance coverage of drugs that have not received federal drug administration approval.

          AN ACT Relating to prescription claims insurance coverage; adding a new section to chapter 48.20 RCW; adding a new section to chapter 48.21 RCW; adding a new section to chapter 48.44 RCW; adding a new section to chapter 48.46 RCW; creating a new section; and declaring an emergency.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:

NEW SECTION. Sec. 1.  The legislature finds that:

          (1) Many health care insurance programs are now screening submitted prescription claims for approved uses as determined by the federal food and drug administration, rejecting prescriptions for what the insurance companies have determined as inappropriate use of the drug.

          (2) Application for approval and marketing of a new drug is a very time consuming and expensive process.

          (3) Once a drug has been approved for the use submitted in the original application, and is marketed, other potential uses for the drug are discovered, and reported in the literature.

          (4) Many times, the drug is used for years for these other conditions before some entity files an application to include these other uses in the labeling.

NEW SECTION. Sec. 2.  A new section is added to chapter 48.20 RCW to read as follows:

          Disability insurance companies may not reject prescription claims based on the use of a drug, if the use is recognized as an appropriate use by equivalent practitioners, or is a recognized or recommended use in the health care literature.  Disability insurance companies may not require contract provisions that constitute a violation of federal or state laws.

NEW SECTION. Sec. 3.  A new section is added to chapter 48.21 RCW to read as follows:

          Group disability insurance companies may not reject prescription claims based on the use of a drug, if the use is recognized as an appropriate use by equivalent practitioners, or is a recognized or recommended use in the health care literature.  Group disability insurance companies may not require contract provisions that constitute a violation of federal or state laws.

NEW SECTION. Sec. 4.  A new section is added to chapter 48.44 RCW to read as follows:

          Health care service companies may not reject prescription claims based on the use of a drug, if the use is recognized as an appropriate use by equivalent practitioners, or is a recognized or recommended use in the health care literature.  The health care service companies may not require contract provisions that constitute a violation of federal or state laws.

NEW SECTION. Sec. 5.  A new section is added to chapter 48.46 RCW to read as follows:

          Health maintenance entities may not reject prescription claims based on the use of a drug, if the use is recognized as an appropriate use by equivalent practitioners, or is a recognized or recommended use in the health care literature.  The health maintenance entities may not require contract provisions that constitute a violation of federal or state laws.

NEW SECTION. Sec. 6.  This act is necessary for the immediate preservation of the public peace, health, or safety, or support of the state government and its existing public institutions, and shall take effect immediately.

                                                           --- END ---