Insurers must cover off-label use of drugs if recognized in which source?

Insurers are required to cover off-label use of drugs when this usage is supported by credible medical reference materials or literature. This requirement aims to ensure that patients receive necessary treatments based on scientific evidence and current medical practices. Medical literature includes peer-reviewed studies, clinical trials, and guidelines from professional medical organizations, all of which provide a robust framework for understanding how a drug can be used effectively outside its approved indications.

The reliance on established medical literature helps to standardize care and ensures that insurance coverage aligns with accepted medical practices. This both protects patient safety and allows healthcare providers to offer the most appropriate treatment options based on evidence rather than solely on regulatory approval processes.

Other sources, such as state offices or commissioner guidance, might not provide the same level of validated medical evidence required to justify off-label drug usage, while the NAIC primarily focuses on insurance regulation rather than clinical practices. Thus, the essential aspect here is the foundation provided by documented medical reference that validates off-label drug uses.