EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
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SENATE BILL 754
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By: Senator Hettleman
Introduced and read first time: February 1, 2024
Assigned to: Finance
A BILL ENTITLED
AN ACT concerning 1
Health Insurance Carriers and Pharmacy Benefits Managers – 2
Clinician–Administered Drugs and Related Services 3
FOR the purpose of prohibiting certain health insurance entities from taking certain 4
actions with respect to the dispensing of clinician–administered drugs and related 5
services; authorizing certain health insurance entities to allow the use of a certain 6
pharmacy or infusion site for an insured or an enrollee to obtain certain 7
clinician–administered drugs and related services; and generally relating to health 8
insurance and clinician–administered drugs and related services. 9
BY repealing and reenacting, with amendments, 10
Article – Insurance 11
Section 15–847(d) 12
Annotated Code of Maryland 13
(2017 Replacement Volume and 2023 Supplement) 14
BY adding to 15
Article – Insurance 16
Section 15–2201 through 15–2203 to be under the new subtitle “Subtitle 22. 17
Clinician–Administered Drugs and Related Services” 18
Annotated Code of Maryland 19
(2017 Replacement Volume and 2023 Supplement) 20
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 21
That the Laws of Maryland read as follows: 22
Article – Insurance 23
15–847. 24
2 SENATE BILL 754
(d) Subject to § 15–805 of this subtitle [and], notwithstanding § 15–806 of this 1
subtitle AND EXCEPT AS PROVID ED UNDER SUBTITLE 22 OF THIS TITLE, nothing in 2
this article or regulations adopted under this article precludes an entity subject to this 3
section from requiring a covered specialty drug to be obtained through: 4
(1) a designated pharmacy or other source authorized under the Health 5
Occupations Article to dispense or administer prescription drugs; or 6
(2) a pharmacy participating in the entity’s provider network, if the entity 7
determines that the pharmacy: 8
(i) meets the entity’s performance standards; and 9
(ii) accepts the entity’s network reimbursement rates. 10
SUBTITLE 22. CLINICIAN–ADMINISTERED DRUGS AND RELATED SERVICES. 11
15–2201. 12
IN THIS S UBTITLE, “CLINICIAN–ADMINISTERED DRUG ” MEANS AN 13
OUTPATIENT PRESCRIPT ION DRUG OTHER THAN A VACCINE THAT : 14
(1) CANNOT REASONABLY BE SELF–ADMINISTERED BY THE PATIENT 15
TO WHOM THE DRUG IS PRESCRIBED OR BY AN INDIVIDUAL ASSISTING THE PATIENT; 16
AND 17
(2) IS TYPICALLY ADMINIS TERED: 18
(I) BY A HEALTH CARE PRO VIDER AUTHORIZED UND ER THE 19
HEALTH OCCUPATIONS ARTICLE TO ADMINISTER THE DRUG , INCLUDING WHEN 20
ACTING UNDER THE DIRECTION AND SUPERVISION OF A PHYSICIAN; AND 21
(II) IN A PHYSICIAN’S OFFICE, HOSPITAL OUTPATIENT INFUSION 22
CENTER, OR OTHER CLINICAL SE TTING. 23
15–2202. 24
(A) THIS SUBTITLE APPLIES TO: 25
(1) INSURERS AND NONPROFIT HEALTH SER VICE PLANS THAT 26
PROVIDE HOSPITAL , MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS 27
ON AN EXPENSE –INCURRED BASIS UNDER HEALTH INSURANCE POL ICIES OR 28
CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE; AND 29
SENATE BILL 754 3
(2) HEALTH MAINTENANCE ORGANIZATIONS THAT P ROVIDE 1
HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS UNDER 2
CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE. 3
(B) AN INSURER, A NONPROFIT HEALTH S ERVICE PLAN , OR A HEALTH 4
MAINTENANCE ORGANIZA TION THAT PROVIDES C OVERAGE FOR PRESCRIPT ION 5
DRUGS THROUGH A PHAR MACY BENEFITS MANAGE R IS SUBJECT TO THE 6
REQUIREMENTS OF THIS SUBTITLE. 7
15–2203. 8
(A) AN ENTITY SUBJECT TO THIS SUBTITLE MAY NOT: 9
(1) REFUSE TO AUTHORIZE , APPROVE, OR PAY A PARTICIPATI NG 10
PROVIDER FOR PROVIDING COVERED CL INICIAN–ADMINISTERED DRUGS A ND 11
RELATED SERVICES TO AN INSURED OR AN ENROLLEE ; 12
(2) IMPOSE COVERAGE OR B ENEFITS LIMITATIONS OR REQUIRE AN 13
INSURED OR AN ENROLLEE TO PAY AN ADDITIONAL FEE, A HIGHER COPAY , A HIGHER 14
COINSURANCE , A SECOND COPAY, A SECOND COINSURANCE , OR OTHER PENALTY 15
WHEN OBTAINING CLINI CIAN–ADMINISTERED DRUGS F ROM: 16
(I) A HEALTH CARE PROVID ER AUTHORIZED UNDE R THE 17
HEALTH OCCUPATIONS ARTICLE TO ADMINISTER CLINIC IAN–ADMINISTERED 18
DRUGS; OR 19
(II) A PHARMACY ; 20
(3) INTERFERE WITH AN INSURED ’S OR ENROLLEE’S RIGHT TO 21
CHOOSE TO OBTAIN A C LINICIAN–ADMINISTERED DRUG FR OM THE INSURED’S OR 22
ENROLLEE’S PROVIDER OR PHARMACY OF CHOICE , INCLUDING THROUGH 23
INDUCEMENT , STEERING, OR THE OFFER OF FINANCIAL OR OTHER I NCENTIVES; 24
(4) REQUIRE THAT ONLY A PHARMACY SELECTED BY THE ENTITY BE 25
AUTHORIZED TO DISPENSE A CLINICIAN–ADMINISTERED DRUG ; 26
(5) LIMIT OR EXCLUDE COV ERAGE FOR A CLINICIA N–ADMINISTERED 27
DRUG WHEN NOT DISPEN SED BY A PHARMACY SE LECTED BY THE ENTITY, IF THE 28
DRUG WOULD OTHERWISE BE COVERED ; 29
(6) REIMBURSE AT A LESSE R AMOUNT CLINICIAN –ADMINISTERED 30
DRUGS DISPENSED BY A PHARMACY NOT SELECTE D BY THE ENTITY; 31
4 SENATE BILL 754
(7) CONDITION, DENY, RESTRICT, REFUSE TO AUTHORIZE OR 1
APPROVE, OR REDUCE PAYMENT TO A PARTICIPATING PROV IDER FOR PROVIDING 2
COVERED CLINICIAN –ADMINISTERED DRUGS A ND RELATED SERVICES TO AN 3
INSURED OR AN ENROLLEE WHEN ALL CRITERIA FO R MEDICAL NECESSITY ARE MET 4
DUE TO THE PARTICIPATING PR OVIDER OBTAIN ING CLINICIAN–ADMINISTERED 5
DRUGS FROM A PHARMAC Y THAT IS NOT A PART ICIPATING PROVIDER IN T HE 6
ENTITY’S NETWORK; 7
(8) REQUIRE THAT AN INSURED OR AN ENROLLEE PAY AN 8
ADDITIONAL FEE , A HIGHER COPAY , A HIGHER COINSURANCE , A SECOND COPAY , A 9
SECOND COINSURANCE , OR ANY OTHER FORM OF PRICE INCREASE FOR 10
CLINICIAN–ADMINISTERED DRUGS IF NOT DISPENSED BY A P HARMACY SELECTED 11
BY THE ENTITY; OR 12
(9) REQUIRE A SPECIALTY PHARMACY TO DISPENSE A 13
CLINICIAN–ADMINISTERED MEDICAT ION DIRECTLY TO AN INSURED OR AN 14
ENROLLEE WITH THE INTENTION T HAT THE INSURED OR ENROLLEE WILL 15
TRANSPORT THE MEDICA TION TO A HEALTH CARE PROVIDER FOR AD MINISTRATION. 16
(B) AN ENTITY SUBJECT TO THIS SUBTITLE MAY ALLOW: 17
(1) THE USE OF A HOME IN FUSION PHARMACY TO D ISPENSE 18
CLINICIAN–ADMINISTERED DRUGS A ND RELATED SERVICES TO AN INSURED OR AN 19
ENROLLEE IN THE HOME OF THE INSURED OR EN ROLLEE; OR 20
(2) THE USE OF AN INFUSI ON SITE EXTERNAL TO THE INSURED’S OR 21
ENROLLEE’S PROVIDER OFFICE OR CLINIC FOR THE DISPE NSING OF 22
CLINICIAN–ADMINISTERED DRUGS A ND RELATED SERVICES . 23
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 24
policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 25
after January 1, 2025. 26
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 27
January 1, 2025. 28