SB 1129 - This act enacts provisions relating to insurance coverage of pharmacy services.CLINICIAN-ADMINISTERED DRUGS (Section 376.411)
This act provides that a health carrier or pharmacy benefits manager (PBM) shall not impose any penalty, impediment, differentiation, or limitation on participating providers for providing medically necessary clinician-administered drugs, regardless of whether the participating provider obtains the drugs from an in-network provider, including but not limited to refusing to approve or pay, or reimbursing less than the contracted payment amount.
Carriers and PBMs shall not impose any penalty, impediment, differentiation, or limitation on a covered person who is administered medically necessary clinician-administered drugs, regardless of whether the participating provider obtains the drugs from an in-network provider, including but not limited to: limiting coverage or benefits; requiring an additional fee, higher co-payment, or higher coinsurance amount; or interfering with a patient's ability to obtain a clinician-administered drug from the patient's provider or pharmacy of choice by any means, including but not limited to inducing, steering, or offering financial or other incentives.
Carriers and PBMs shall not impose any penalty, impediment, differentiation, or limitation on any pharmacy that is dispensing medically necessary clinician-administered drugs, regardless of whether the participating provider obtains the drugs from an in-network provider, including but not limited to requiring a pharmacy to dispense the drugs to a patient with the intention that the patient will transport the medication to a health care provider for administration.
These provisions shall not apply if the clinician-administered drug is not otherwise covered by the carrier or PBM.
340B DRUG PRICING (Section 376.413)
Under this act, a health carrier or PBM shall not discriminate, lower the reimbursement, or impose any separate terms upon an entity in any contract based in whole or in part on the entity's participation in the 340B drug pricing program under federal law, as detailed in the act. A health carrier or PBM shall not limit a patient's freedom to use an entity that participates in the 340B pricing program by any means, including but not limited to modifying a patient's payment limitations or cost-sharing obligations on the basis of participation in the 340B pricing program.
A PBM shall not base drug formulary or drug coverage decisions on the 340B pricing status of a drug, including price or availability, or whether a dispensing entity participates in the 340B pricing program.
A pharmaceutical manufacturer shall not prohibit an entity from contracting or participating with an entity authorized to participate in the 340B pricing program by denying access to drugs that are manufactured by the pharmaceutical manufacturer, or by denying the entity the ability to purchase drugs at the 340B price by substituting a rebate discount.
All pharmacy claims processed by a pharmacy participating in the 340B pricing program shall be final at the point of adjudication.
These provisions are identical to provisions in HB 2305 (2022), and similar to provisions in SB 921 (2022), provisions in SB 1129 (2022), provisions in HB 2305 (2022), provisions in SB 971 (2020), provisions in HCS/HB 2412 (2020), provisions in the truly agreed to and finally passed SS/SCS/HCS/HB 1682 (2020), provisions in HB 1910 (2020), provisions in SB 413 (2019), and provisions in HB 1165 (2019).
REFERENCE PRODUCTS AND BIOSIMILARS (Section 376.415)
A health carrier or PBM providing coverage for a reference product or a biological product that is biosimilar to the reference product shall provide coverage for the reference product and all biological products that have been deemed biosimilar to the reference product. The scope, extent, and amount of the required coverage shall be the same, including but not limited to any payment limitations or cost-sharing obligations.
This act is identical to HB 2305 (2022).
ERIC VANDER WEERD