Bill > H1313

This bill aims to protect patients' rights when receiving clinician-administered drugs (prescription medications that cannot be easily self-administered and are typically given by healthcare providers in clinical settings) by establishing new regulations for health benefit carriers. The bill prohibits health insurance providers from restricting patients' choices about where they can obtain these drugs, preventing carriers from refusing authorization, imposing additional fees, or requiring patients to use a specific pharmacy. Specifically, carriers cannot impose extra copays or coinsurance when patients obtain drugs from their preferred healthcare provider or pharmacy, cannot steer patients toward specific pharmacies, and cannot reimburse drugs at a lower rate if they are obtained from a non-preferred pharmacy. The bill also prevents carriers from conditioning, denying, or reducing payment to healthcare providers based on where they source clinician-administered drugs. While carriers may offer options like home infusion pharmacies, they cannot mandate their use. The proposed legislation ultimately seeks to give patients more flexibility and control in obtaining necessary medical treatments by removing barriers created by health insurance network restrictions.

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https://malegislature.gov/Bills/194/H1313