Montana Senate Bill SB223

Montana 2023 Regular Session

• Introduced: 1/26/23
• Refer: 1/27/23

Caption

Establish requirements for insurance coverage of clinician-administered drugs

Impact

If enacted, SB223 would significantly impact insurance practices within the state by preventing health insurance issuers from denying coverage based on the pharmacy chosen by policyholders for clinician-administered drugs. It would also eliminate extra fees associated with obtaining medications outside the insurer’s preferred pharmacy network. This legislation aligns with broader efforts to improve patient autonomy and to ensure that healthcare services remain accessible without added costs or complications stemming from insurer preferences.

Summary

Senate Bill 223 aims to establish requirements for insurance coverage of clinician-administered drugs in the state of Montana. It seeks to mandate that health insurance policies refrain from imposing burdensome restrictions on the coverage of these drugs, ensuring that patients can receive necessary medications without unnecessary financial penalties or limitations. The bill serves to protect the right of insured individuals to obtain medications from their preferred healthcare providers or pharmacies, and prohibits insurers from steering patients towards specific pharmacies through financial incentives.

Contention

Discussion around SB223 reveals some contention, particularly among insurance providers concerned about how these mandated changes might affect their operational flexibility and financial models. Critics of the bill worry that it may lead to increased costs for insurance companies, potentially resulting in higher premiums for policyholders or reduced coverage for other necessary services. Proponents argue that the bill addresses significant consumer rights issues, ensuring that patients are not penalized for choosing providers according to their healthcare needs.