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Can my group medical insurance refuse to cover the new HIV drugs I need?
Mar 24, 1997

Can my group medical insurance refuse to cover the new HIV drugs I need?

Response from Ms. Breuer

Yes. If the drugs are considered "experimental or investigational," the insurance company can deny coverage. This is usually defined as a drug not yet recognized throughout the medical profession in the U.S. as safe and effective for the diagnosis or treatment for the illness. This would include all phases of clinical trials, all treatment protocols based upon or similar to those used in clinical trials, drugs approved by the FDA but used for unrecognized treatmment indications, and drugs approved by the FDA under its Treatment Investigational New Drug regulation. However, I would recommend that you check with your insurance company to see if particular drugs are covered.



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