Bill > H4956

This bill, relating to patient choice in dispensing of clinician-administered drugs, amends Chapter 176O of the General Laws by adding a new section that clarifies patient rights when obtaining certain medications. A "clinician-administered drug" is defined as an outpatient prescription drug, excluding vaccines, that a patient cannot reasonably self-administer and is typically given by a healthcare provider in a clinical setting. The bill's key provisions state that health benefit carriers, which are insurance companies, cannot refuse to authorize or pay for these drugs when provided by a participating doctor or clinic, nor can they impose extra costs or penalties on patients who obtain them from their chosen provider or pharmacy. Insurers are also prohibited from steering patients towards specific pharmacies, limiting coverage if a drug isn't dispensed by a plan-selected pharmacy, or reimbursing at a lower rate for drugs from non-selected pharmacies. The bill ensures that coverage for these drugs won't be denied or reduced if the provider obtains them from a pharmacy outside the insurer's network, as long as medical necessity criteria are met. Finally, it clarifies that while insurers can offer options like home infusion pharmacies or external infusion sites, they cannot mandate their use.

Health and Social Services

Joint Committee on Financial Services (Joint)

https://malegislature.gov/Bills/194/H4956