Maryland 2024 Regular Session

Maryland Senate Bill SB754 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4	4	[Brackets] indicate matter deleted from existing law.
5	5	sb0754
6	6
7	7	SENATE BILL 754
8	8	J5 4lr2645
9	9	CF 4lr3315
10	10	By: Senator Hettleman
11	11	Introduced and read first time: February 1, 2024
12	12	Assigned to: Finance
13	13
14	14	A BILL ENTITLED
15	15
16	16	AN ACT concerning 1
17	17
18	18	Health Insurance Carriers and Pharmacy Benefits Managers – 2
19	19	Clinician–Administered Drugs and Related Services 3
20	20
21	21	FOR the purpose of prohibiting certain health insurance entities from taking certain 4
22	22	actions with respect to the dispensing of clinician–administered drugs and related 5
23	23	services; authorizing certain health insurance entities to allow the use of a certain 6
24	24	pharmacy or infusion site for an insured or an enrollee to obtain certain 7
25	25	clinician–administered drugs and related services; and generally relating to health 8
26	26	insurance and clinician–administered drugs and related services. 9
27	27
28	28	BY repealing and reenacting, with amendments, 10
29	29	Article – Insurance 11
30	30	Section 15–847(d) 12
31	31	Annotated Code of Maryland 13
32	32	(2017 Replacement Volume and 2023 Supplement) 14
33	33
34	34	BY adding to 15
35	35	Article – Insurance 16
36	36	Section 15–2201 through 15–2203 to be under the new subtitle “Subtitle 22. 17
37	37	Clinician–Administered Drugs and Related Services” 18
38	38	Annotated Code of Maryland 19
39	39	(2017 Replacement Volume and 2023 Supplement) 20
40	40
41	41	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 21
42	42	That the Laws of Maryland read as follows: 22
43	43
44	44	Article – Insurance 23
45	45
46	46	15–847. 24
47	47	2 SENATE BILL 754
48	48
49	49
50	50	(d) Subject to § 15–805 of this subtitle [and], notwithstanding § 15–806 of this 1
51	51	subtitle AND EXCEPT AS PROVID ED UNDER SUBTITLE 22 OF THIS TITLE, nothing in 2
52	52	this article or regulations adopted under this article precludes an entity subject to this 3
53	53	section from requiring a covered specialty drug to be obtained through: 4
54	54
55	55	(1) a designated pharmacy or other source authorized under the Health 5
56	56	Occupations Article to dispense or administer prescription drugs; or 6
57	57
58	58	(2) a pharmacy participating in the entity’s provider network, if the entity 7
59	59	determines that the pharmacy: 8
60	60
61	61	(i) meets the entity’s performance standards; and 9
62	62
63	63	(ii) accepts the entity’s network reimbursement rates. 10
64	64
65	65	SUBTITLE 22. CLINICIAN–ADMINISTERED DRUGS AND RELATED SERVICES. 11
66	66
67	67	15–2201. 12
68	68
69	69	IN THIS S UBTITLE, “CLINICIAN–ADMINISTERED DRUG ” MEANS AN 13
70	70	OUTPATIENT PRESCRIPT ION DRUG OTHER THAN A VACCINE THAT : 14
71	71
72	72	(1) CANNOT REASONABLY BE SELF–ADMINISTERED BY THE PATIENT 15
73	73	TO WHOM THE DRUG IS PRESCRIBED OR BY AN INDIVIDUAL ASSISTING THE PATIENT; 16
74	74	AND 17
75	75
76	76	(2) IS TYPICALLY ADMINIS TERED: 18
77	77
78	78	(I) BY A HEALTH CARE PRO VIDER AUTHORIZED UND ER THE 19
79	79	HEALTH OCCUPATIONS ARTICLE TO ADMINISTER THE DRUG , INCLUDING WHEN 20
80	80	ACTING UNDER THE DIRECTION AND SUPERVISION OF A PHYSICIAN; AND 21
81	81
82	82	(II) IN A PHYSICIAN’S OFFICE, HOSPITAL OUTPATIENT INFUSION 22
83	83	CENTER, OR OTHER CLINICAL SE TTING. 23
84	84
85	85	15–2202. 24
86	86
87	87	(A) THIS SUBTITLE APPLIES TO: 25
88	88
89	89	(1) INSURERS AND NONPROFIT HEALTH SER VICE PLANS THAT 26
90	90	PROVIDE HOSPITAL , MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS 27
91	91	ON AN EXPENSE –INCURRED BASIS UNDER HEALTH INSURANCE POL ICIES OR 28
92	92	CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE; AND 29
93	93	SENATE BILL 754 3
94	94
95	95
96	96	(2) HEALTH MAINTENANCE ORGANIZATIONS THAT P ROVIDE 1
97	97	HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS UNDER 2
98	98	CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE. 3
99	99
100	100	(B) AN INSURER, A NONPROFIT HEALTH S ERVICE PLAN , OR A HEALTH 4
101	101	MAINTENANCE ORGANIZA TION THAT PROVIDES C OVERAGE FOR PRESCRIPT ION 5
102	102	DRUGS THROUGH A PHAR MACY BENEFITS MANAGE R IS SUBJECT TO THE 6
103	103	REQUIREMENTS OF THIS SUBTITLE. 7
104	104
105	105	15–2203. 8
106	106
107	107	(A) AN ENTITY SUBJECT TO THIS SUBTITLE MAY NOT: 9
108	108
109	109	(1) REFUSE TO AUTHORIZE , APPROVE, OR PAY A PARTICIPATI NG 10
110	110	PROVIDER FOR PROVIDING COVERED CL INICIAN–ADMINISTERED DRUGS A ND 11
111	111	RELATED SERVICES TO AN INSURED OR AN ENROLLEE ; 12
112	112
113	113	(2) IMPOSE COVERAGE OR B ENEFITS LIMITATIONS OR REQUIRE AN 13
114	114	INSURED OR AN ENROLLEE TO PAY AN ADDITIONAL FEE, A HIGHER COPAY , A HIGHER 14
115	115	COINSURANCE , A SECOND COPAY, A SECOND COINSURANCE , OR OTHER PENALTY 15
116	116	WHEN OBTAINING CLINI CIAN–ADMINISTERED DRUGS F ROM: 16
117	117
118	118	(I) A HEALTH CARE PROVID ER AUTHORIZED UNDE R THE 17
119	119	HEALTH OCCUPATIONS ARTICLE TO ADMINISTER CLINIC IAN–ADMINISTERED 18
120	120	DRUGS; OR 19
121	121
122	122	(II) A PHARMACY ; 20
123	123
124	124	(3) INTERFERE WITH AN INSURED ’S OR ENROLLEE’S RIGHT TO 21
125	125	CHOOSE TO OBTAIN A C LINICIAN–ADMINISTERED DRUG FR OM THE INSURED’S OR 22
126	126	ENROLLEE’S PROVIDER OR PHARMACY OF CHOICE , INCLUDING THROUGH 23
127	127	INDUCEMENT , STEERING, OR THE OFFER OF FINANCIAL OR OTHER I NCENTIVES; 24
128	128
129	129	(4) REQUIRE THAT ONLY A PHARMACY SELECTED BY THE ENTITY BE 25
130	130	AUTHORIZED TO DISPENSE A CLINICIAN–ADMINISTERED DRUG ; 26
131	131
132	132	(5) LIMIT OR EXCLUDE COV ERAGE FOR A CLINICIA N–ADMINISTERED 27
133	133	DRUG WHEN NOT DISPEN SED BY A PHARMACY SE LECTED BY THE ENTITY, IF THE 28
134	134	DRUG WOULD OTHERWISE BE COVERED ; 29
135	135
136	136	(6) REIMBURSE AT A LESSE R AMOUNT CLINICIAN –ADMINISTERED 30
137	137	DRUGS DISPENSED BY A PHARMACY NOT SELECTE D BY THE ENTITY; 31
138	138	4 SENATE BILL 754
139	139
140	140
141	141	(7) CONDITION, DENY, RESTRICT, REFUSE TO AUTHORIZE OR 1
142	142	APPROVE, OR REDUCE PAYMENT TO A PARTICIPATING PROV IDER FOR PROVIDING 2
143	143	COVERED CLINICIAN –ADMINISTERED DRUGS A ND RELATED SERVICES TO AN 3
144	144	INSURED OR AN ENROLLEE WHEN ALL CRITERIA FO R MEDICAL NECESSITY ARE MET 4
145	145	DUE TO THE PARTICIPATING PR OVIDER OBTAIN ING CLINICIAN–ADMINISTERED 5
146	146	DRUGS FROM A PHARMAC Y THAT IS NOT A PART ICIPATING PROVIDER IN T HE 6
147	147	ENTITY’S NETWORK; 7
148	148
149	149	(8) REQUIRE THAT AN INSURED OR AN ENROLLEE PAY AN 8
150	150	ADDITIONAL FEE , A HIGHER COPAY , A HIGHER COINSURANCE , A SECOND COPAY , A 9
151	151	SECOND COINSURANCE , OR ANY OTHER FORM OF PRICE INCREASE FOR 10
152	152	CLINICIAN–ADMINISTERED DRUGS IF NOT DISPENSED BY A P HARMACY SELECTED 11
153	153	BY THE ENTITY; OR 12
154	154
155	155	(9) REQUIRE A SPECIALTY PHARMACY TO DISPENSE A 13
156	156	CLINICIAN–ADMINISTERED MEDICAT ION DIRECTLY TO AN INSURED OR AN 14
157	157	ENROLLEE WITH THE INTENTION T HAT THE INSURED OR ENROLLEE WILL 15
158	158	TRANSPORT THE MEDICA TION TO A HEALTH CARE PROVIDER FOR AD MINISTRATION. 16
159	159
160	160	(B) AN ENTITY SUBJECT TO THIS SUBTITLE MAY ALLOW: 17
161	161
162	162	(1) THE USE OF A HOME IN FUSION PHARMACY TO D ISPENSE 18
163	163	CLINICIAN–ADMINISTERED DRUGS A ND RELATED SERVICES TO AN INSURED OR AN 19
164	164	ENROLLEE IN THE HOME OF THE INSURED OR EN ROLLEE; OR 20
165	165
166	166	(2) THE USE OF AN INFUSI ON SITE EXTERNAL TO THE INSURED’S OR 21
167	167	ENROLLEE’S PROVIDER OFFICE OR CLINIC FOR THE DISPE NSING OF 22
168	168	CLINICIAN–ADMINISTERED DRUGS A ND RELATED SERVICES . 23
169	169
170	170	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 24
171	171	policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 25
172	172	after January 1, 2025. 26
173	173
174	174	SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 27
175	175	January 1, 2025. 28