Insurance Coverage for Provider-Administered Drugs

For the treatment of cancer or a life-threatening disease or for the treatment of a symptom, complication, or consequence of cancer or a life-threatening disease, the act prohibits a carrier, with respect to a health benefit plan issued on or after January 1, 2025, from:

• Requiring a provider-administered drug to be dispensed only by specific network pharmacies;
• If a provider-administered drug is otherwise covered by the carrier for the covered person, limiting or excluding coverage for the drug based on the covered person's choice of participating provider;
• Requiring a participating provider to bill for or be reimbursed for the delivery and administration of a provider-administered drug under the pharmacy benefit instead of the medical benefit without informed, written consent of the covered person and written attestation by the covered person's participating provider that a delay in the drug's administration will not place the covered person at an increased health risk; or
• Requiring a covered person to pay additional fees, copayments, or coinsurance based on the covered person's choice of pharmacy.

The act also requires the reimbursement rate for covered provider-administered drugs to be at the carrier's in-network negotiated rate for participating providers.

The act appropriates $7,333 to the department of regulatory agencies for use by the division of insurance from the division of insurance cash fund to implement the act.

VETOED by Governor May 17, 2024
(Note: This summary applies to this bill as enacted.)