▸SECTION 1
Chapter 176O of the General Laws is hereby amended by inserting after section 30 the following section:-
▸SECTION 31
(a) In this section:
(1) "Clinician-administered drug" means an outpatient prescription drug other than a vaccine that:
(A) cannot reasonably be self-administered by the patient to whom the drug is prescribed or by an individual assisting the patient with the self-administration; and
(B) is typically administered:
(i) by a health care provider authorized under the laws of this state to administer the drug, including when acting under a physician ’s delegation and supervision; and
(ii) in a physician’s office, hospital outpatient infusion center, or other clinical setting.
(b) A health benefit carrier:
(1) shall not refuse to authorize, approve, or pay a participating provider for providing covered clinician-administered drugs and related services to covered persons;
(2) shall not impose coverage or benefits limitations, or require an enrollee to pay an additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or other penalty when obtaining clinician-administered drugs from a health care provider authorized under the laws of this state to administer clinician-administered drugs, or a pharmacy;
(3) shall not interfere with the patient's right to choose to obtain a clinician-administered drug from their provider or pharmacy of choice, including inducement, steering, or offering financial or other incentives;
(4) shall not require clinician-administered drugs to be dispensed by a pharmacy selected by the health plan;
(5) shall not limit or exclude coverage for a clinician-administered drug when not dispensed by a pharmacy selected by the health plan, if such drug would otherwise be covered;
(6) shall not reimburse at a lesser amount clinician-administered drugs dispensed by a pharmacy not selected by the health plan;
(7) shall not condition, deny, restrict, refuse to authorize or approve, or reduce payment to a participating provider for providing covered clinician-administered drugs and related services to covered persons when all criteria for medical necessity are met, because the participating provider obtains clinician-administered drugs from a pharmacy that is not a participating provider in the health benefit issuer’s network;
(8) shall not require that an enrollee pay an additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or any other form of price increase for clinician-administered drugs when not dispensed by a pharmacy selected by the health plan;
(9) shall not require a specialty pharmacy to dispense a clinician-administered medication directly to a patient with the intention that the patient will transport the medication to a healthcare provider for administration
(c) A health benefit carrier may offer, but shall not require:
(1) the use of a home infusion pharmacy to dispense clinician-administered drugs to patients in their homes or;
(2) the use of an infusion site external to a patient’s provider office or clinic.
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SECTION 1. Chapter 176O of the General Laws is hereby amended by inserting after section 30 the following section:-
Section 31. (a) In this section:
(1) "Clinician-administered drug" means an outpatient prescription drug other than a vaccine that:
(A) cannot reasonably be self-administered by the patient to whom the drug is prescribed or by an individual assisting the patient with the self-administration; and
(B) is typically administered:
(i) by a health care provider authorized under the laws of this state to administer the drug, including when acting under a physician ’s delegation and supervision; and
(ii) in a physician’s office, hospital outpatient infusion center, or other clinical setting.
(b) A health benefit carrier:
(1) shall not refuse to authorize, approve, or pay a participating provider for providing covered clinician-administered drugs and related services to covered persons;
(2) shall not impose coverage or benefits limitations, or require an enrollee to pay an additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or other penalty when obtaining clinician-administered drugs from a health care provider authorized under the laws of this state to administer clinician-administered drugs, or a pharmacy;
(3) shall not interfere with the patient's right to choose to obtain a clinician-administered drug from their provider or pharmacy of choice, including inducement, steering, or offering financial or other incentives;
(4) shall not require clinician-administered drugs to be dispensed by a pharmacy selected by the health plan;
(5) shall not limit or exclude coverage for a clinician-administered drug when not dispensed by a pharmacy selected by the health plan, if such drug would otherwise be covered;
(6) shall not reimburse at a lesser amount clinician-administered drugs dispensed by a pharmacy not selected by the health plan;
(7) shall not condition, deny, restrict, refuse to authorize or approve, or reduce payment to a participating provider for providing covered clinician-administered drugs and related services to covered persons when all criteria for medical necessity are met, because the participating provider obtains clinician-administered drugs from a pharmacy that is not a participating provider in the health benefit issuer’s network;
(8) shall not require that an enrollee pay an additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or any other form of price increase for clinician-administered drugs when not dispensed by a pharmacy selected by the health plan;
(9) shall not require a specialty pharmacy to dispense a clinician-administered medication directly to a patient with the intention that the patient will transport the medication to a healthcare provider for administration
(c) A health benefit carrier may offer, but shall not require:
(1) the use of a home infusion pharmacy to dispense clinician-administered drugs to patients in their homes or;
(2) the use of an infusion site external to a patient’s provider office or clinic.