Alabama 2025 Regular Session

Alabama Senate Bill SB43 Compare Versions

Version 1 (Old)

Version 2 (New)

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1		-	~~SB43ENGROSSED~~
	1	+	SB43INTRODUCED
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3	3		SB43
4		-	~~V77HFLL-2~~
	4	+	UJFIGXG-1
5	5		By Senator Melson
6	6		RFD: Banking and Insurance
7	7		First Read: 04-Feb-25
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12		-	5 ~~SB43 Engrossed~~
	12	+	5 UJFIGXG-1 02/04/2025 JC (L)lg 2025-144
13	13		Page 1
14	14		First Read: 04-Feb-25
	15	+	SYNOPSIS:
	16	+	This bill would prohibit health insurance
	17	+	companies from regulating what physicians, other health
	18	+	care providers, and pharmacists may tell patients about
	19	+	the cost of the treatment or medication they are
	20	+	receiving, or from informing patients about alternative
	21	+	treatments or medications that may be lower in cost.
	22	+	This bill would provide that any contractual
	23	+	clause prohibiting a health care provider or pharmacist
	24	+	from sharing information about costs and alternative
	25	+	treatments or medications, or penalizing a health care
	26	+	provider or pharmacist for providing this information,
	27	+	would be unenforceable.
	28	+	This bill would prohibit health insurers from
	29	+	taking action against a health care provider or
	30	+	pharmacist for providing such information.
	31	+	This bill would further permit a health care
	32	+	provider or pharmacist to recover damages from a health
	33	+	care insurer who takes adverse action, on the basis of
	34	+	a contract or otherwise.
15	35		A BILL
16	36		TO BE ENTITLED
17	37		AN ACT
18		-	Relating to health care providers; to bar enforcement
19		-	of contractual provisions that apply to health care providers
20		-	and pharmacists which forbid or penalize disclosure of
21		-	information to patients or other individuals about the cost
22		-	and availability of treatment or drugs; to prohibit
23		-	contractors from taking adverse action against health care
24		-	providers and pharmacists for disclosing cost and treatment
25		-	information to patients or other individuals; and to provide a
26		-	civil action to health care providers and pharmacists.
27		-	BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
28		-	Section 1.(a) For the purposes of this section, the
29		-	following terms have the following meanings:
30		-	(1) HEALTH CARE PROVIDER. The term includes:
31		-	a. A pharmacist licensed pursuant to Chapter 23 of
32		-	Title 34, Code of Alabama 1975.
33		-	b. A physician or other health care professional
34		-	licensed pursuant to Chapter 24 of Title 34, Code of Alabama
35		-	1975.
36		-	c. An optometrist licensed pursuant to Chapter 22 of
37		-	Title 34, Code of Alabama 1975.
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65		-	28 SB43 ~~Engrossed~~
	65	+	28 SB43 INTRODUCED
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	67	+	AN ACT
	68	+	Relating to health care providers; to bar enforcement
	69	+	of contractual provisions between health insurers and health
	70	+	care providers and pharmacists which forbid or penalize
	71	+	disclosure of information to patients about the cost and
	72	+	availability of treatment or drugs; to prohibit health
	73	+	insurers from taking adverse action against health care
	74	+	providers and pharmacists for disclosing cost and treatment
	75	+	information to patients; and to provide a civil action to
	76	+	health care providers and pharmacists.
	77	+	BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
	78	+	Section 1.(a) For the purposes of this section, the
	79	+	following terms have the following meanings:
	80	+	(1) HEALTH CARE PROVIDER. The term includes:
	81	+	a. A pharmacist licensed pursuant to Chapter 23 of
67	82		Title 34, Code of Alabama 1975.
	83	+	b. A physician or other health care professional
	84	+	licensed pursuant to Chapter 24 of Title 34, Code of Alabama
	85	+	1975.
68	86		(2) HEALTH INSURER. An entity subject to the insurance
69	87		laws of this state and the rules of the Department of
70	88		Insurance of the State of Alabama, or a health maintenance
71	89		organization operating pursuant to Chapter 21A of Title 27,
72	90		Code of Alabama 1975, or a nonprofit hospital or health
73	91		service corporation organized pursuant to Article 6, Chapter
74	92		20 of Title 10A, Code of Alabama 1975, that contracts or
75	93		offers to contract to provide, deliver, arrange for, pay for,
76	94		or reimburse any of the costs of physical, mental, or
77		-	behavioral health care services, including pharmaceutical
78		-	services, or a nonprofit agricultural organization that
79		-	provides a plan for health care benefits to its members. The
80		-	term includes a pharmacy benefits manager or pharmacy benefits
81		-	manager affiliate subject to the licensure requirements of
82		-	Chapter 45A of Title 27, Code of Alabama 1975, or any other
83		-	entity providing a plan of health insurance, health benefits,
84		-	or health services.
85		-	(3) OTHER CONTRACTING ENTITY. The term includes all of
86		-	the following:
87		-	a. A hospital, nursing home, or health care institution
88		-	licensed under Article 2, Chapter 21, Title 22, Code of
89		-	Alabama 1975.
90		-	b. An institution that provides postsecondary
91		-	education, laboratory services, or performs clinical research.
92		-	c. A manufacturer, distributor, or supplier of drugs,
93		-	medical devices, diagnostic equipment, durable medical
94		-	equipment, or any other service or product that may be used in
95		-	providing health care.
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123		-	56 SB43 ~~Engrossed~~
	122	+	56 SB43 INTRODUCED
124	123		Page 3
125		-	providing health care.
126		-	(b)(1) Subject to the limitations set forth in Sections
127		-	34-23-8 and 34-23-8.1, Code of Alabama 1975, a health care
128		-	provider, in the scope of his or her professional practice,
129		-	may provide a patient or customer with any of the following
130		-	information:
131		-	a. The estimated cost of a treatment or drug, including
132		-	the cost in the absence of insurance coverage; the allowed
133		-	amount for payment or reimbursement under a plan of health
134		-	benefits; and a cost-sharing amount to be owed by a patient or
135		-	customer, such as a deductible, copayment, or coinsurance.
136		-	b. A treatment or drug that is less expensive than the
	124	+	or reimburse any of the costs of physical, mental, or
	125	+	behavioral health care services, including pharmaceutical
	126	+	services. The term includes a pharmacy benefits manager or
	127	+	pharmacy benefits manager affiliate subject to the licensure
	128	+	requirements of Chapter 45A of Title 27, Code of Alabama 1975,
	129	+	or any other entity providing a plan of health insurance,
	130	+	health benefits, or health services.
	131	+	(3) INDIVIDUAL. A patient of a physician or other
	132	+	health care professional or a customer of a pharmacist.
	133	+	(b) Subject to the limitations set in Sections 34-23-8
	134	+	and 34-23-8.1, Code of Alabama 1975, a health care provider,
	135	+	in the scope of his or her professional practice, may provide
	136	+	an individual with any of the following information:
	137	+	(1) The estimated cost of a treatment or drug,
	138	+	including the cost in the absence of insurance coverage; the
	139	+	allowed amount for payment or reimbursement under a plan of
	140	+	health benefits; and an individual's cost-sharing amount, such
	141	+	as a deductible, copayment, or coinsurance.
	142	+	(2) A treatment or drug that is less expensive than the
137	143		treatment or drug under consideration between the health care
138		-	provider and the ~~patient or customer~~.
139		-	c. The availability of a treatment or drug that is an
	144	+	provider and the individual.
	145	+	(3) The availability of a treatment or drug that is an
140	146		alternative to the treatment or drug under consideration
141		-	between the health care provider and the patient or customer,
142		-	including the off-label use of the treatment or drug, provided
143		-	that it is within the standard of care for treatment of the
144		-	disease, condition, or symptom of the individual.
145		-	(2) A health care provider, relying upon professional
146		-	knowledge or experience that is within the standard of care of
147		-	his or her profession or specialty, may opine on or otherwise
148		-	provide an individual with information on any of the following
149		-	topics:
150		-	a. The cost of a treatment or drug.
151		-	b. The comparative costs of treatment or drugs that are
152		-	available for the treatment of a disease, condition, or
153		-	symptom.
	147	+	between the health care provider and the individual, including
	148	+	the off-label use of the treatment or drug, provided that it
	149	+	is within the standard of care for treatment of the disease,
	150	+	condition, or symptom of the individual.
	151	+	(c)(1) A health insurer may not cancel or refuse to
	152	+	renew a contract with a health care provider, or penalize or
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183		-	symptom.
184		-	c. The comparative effectiveness of available
185		-	treatments or drugs, including so-called alternative
186		-	treatments or drugs or the off-label use of treatments or
187		-	drugs, for the treatment of a disease, condition, or symptom.
188		-	(c)(1) A health insurer or other contracting entity may
189		-	not cancel or refuse to renew a contract with a health care
190		-	provider, or penalize or take any adverse action against a
191		-	health care provider, regardless of whether the penalty or
192		-	adverse action is provided for in a contract, or otherwise
193		-	retaliate against a health care provider, as a result of the
194		-	health care provider providing a patient, customer, or other
195		-	individual with any information described in subsection (b).
	182	+	renew a contract with a health care provider, or penalize or
	183	+	take any adverse action against a health care provider,
	184	+	regardless of whether the penalty or adverse action is
	185	+	provided for in a contract, or otherwise retaliate against a
	186	+	health care provider, as a result of the health care provider
	187	+	providing an individual with any information described in
	188	+	subsection (b).
196	189		(2) Any provision in a contract between a health
197		-	insurer or other contracting entity and a health care provider
198		-	that prohibits a health care provider from providing a
199		-	patient, customer, or other individual with the information
200		-	described in subsection (b), or which otherwise imposes any
201		-	penalty, adverse consequence, or monetary disincentive on a
202		-	health care provider for providing a patient, customer, or
203		-	other individual with the information described in subsection
204		-	(b), is unenforceable in the courts of the State of Alabama.
	190	+	insurer and a health care provider that prohibits a health
	191	+	care provider from providing an individual with the
	192	+	information described in subsection (b), or which otherwise
	193	+	imposes any penalty, adverse consequence, or monetary
	194	+	disincentive on a health care provider for providing an
	195	+	individual with the information described in subsection (b),
	196	+	is unenforceable in the courts of the State of Alabama.
205	197		(d) A health care provider who suffers adverse action
206	198		as described in subsection (c) may bring an action against a
207		-	health insurer or other contracting entity in the circuit
208		-	court of the county in which the contract with the health
209		-	insurer or other contracting entity is performed by the health
	199	+	health insurer in the circuit court of the county in which the
	200	+	contract with the health insurer is performed by the health
210	201		care provider, for the following:
211	202		(1) Actual damages.
	203	+	(2) Equitable relief.
	204	+	(3) Reasonable costs and attorney fees.
	205	+	Section 2. This act shall become effective on October
	206	+	1, 2025.
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241		-	(1) Actual damages.
242		-	(2) Equitable relief.
243		-	(3) Reasonable costs and attorney fees.
244		-	Section 2. This act shall become effective on October
245		-	1, 2025.
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251		-	1, 2025.
252		-	Senate
253		-	Read for the first time and referred
254		-	to the Senate committee on Banking
255		-	and Insurance
256		-	................04-Feb-25
257		-	Read for the second time and placed
258		-	on the calendar:
259		-	0 amendments
260		-	................05-Mar-25
261		-	Read for the third time and passed
262		-	as amended
263		-	Yeas 33
264		-	Nays 0
265		-	Abstains 0
266		-	................08-Apr-25
267		-	Patrick Harris,
268		-	Secretary.
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