HB198--PHARMACYSERVICESINSURANCECOVERAGE
SPONSOR:Wright
Thisbillestablishesrequirementsforinsurancecoverageofcertainpharmacyservices.Thisbill
providesthatahealthcarrier,pharmacybenefitsmanager,oragentofsuchentitiesareprohibited
fromimposinganypenalty,impediment,differentiation,orlimitationon:
(1)Participatingprovidersforprovidingmedicallynecessaryclinician-administereddrugs,
regardlessofwhethertheparticipatingproviderobtainssuchdrugsfromaproviderthatisinthe
network;
(2)Apersonwhoisadministeredmedicallynecessaryclinicianadministereddrugsregardlessof
whethertheparticipatingproviderobtainssuchdrugsfromaproviderthatisinthenetwork;or
(3)Anypharmacy,includinganyclassBhospitalpharmacyasdefinedinSection338.220,RSMo,
thatisdispensingmedicallynecessaryclinician-administereddrugsregardlessofwhetherthe
participatingproviderobtainssuchdrugsfromaproviderthatisinthenetwork.
Thisprohibitiondoesnotapplyiftheclinician-administereddrugisnototherwisecoveredbythe
healthcarrierorpharmacybenefitsmanager.
Ahealthcarrier,pharmacybenefitsmanager,oragentofsuchentitiesmaynotdiscriminate,lower
thereimbursement,orimposeanyseparatecontracttermsuponanentitybaseduponthatentity's
participationinthe340Bdrugpricingprogram,describedin42U.S.C.Section256b,orlimita
patient'sfreedomtouseanysuchentity,asdescribedinthebill.
Allpharmacyclaimsprocessedbyapharmacythatparticipatesinthe340Bdrugpricingprogram
arefinalatthepointofadjudication.
Thisbilldefines"biologicalproduct","biosimilarproduct",and"referenceproduct"ashavingthe
samemeaningasgiventothetermsunderfederallaw.Ahealthcarrier,pharmacybenefits
manager,oragentofsuchentitiesthatprovidescoverageforareferenceproductorbiosimilar
biologicalproductmustprovidecoverageforthereferenceproductandallbiologicalproductsthat
havebeendeemedbiosimilartothereferenceproduct.
ThisbillisthesameasHB2305(2022).