Rhode Island 2023 Regular Session

Rhode Island Senate Bill S0870 Compare Versions

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

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5	5	2023 -- S 0870
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7	7	LC002496
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9	9	S T A T E O F R H O D E I S L A N D
10	10	IN GENERAL ASSEMBLY
11	11	JANUARY SESSION, A.D. 2023
12	12	____________
13	13
14	14	A N A C T
15	15	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
16	16	Introduced By: Senators Ujifusa, Miller, Lawson, Valverde, Lauria, Kallman, Zurier,
17	17	DiMario, Euer, and DiPalma
18	18	Date Introduced: March 30, 2023
19	19	Referred To: Senate Health & Human Services
20	20
21	21
22	22	It is enacted by the General Assembly as follows:
23	23	SECTION 1. Chapter 27-18 of the General Laws entitled "Accident and Sickness Insurance 1
24	24	Policies" is hereby amended by adding thereto the following section: 2
25	25	27-18-33.3. Patient choice in dispensing of clinician-administered drugs. 3
26	26	(a) As used in this section: 4
27	27	(1) "Clinician-administered drug" means an outpatient prescription drug other than a 5
28	28	vaccine that: 6
29	29	(i) Cannot reasonably be self-administered by the patient to whom the drug is prescribed 7
30	30	or by an individual assisting the patient with the self-administration; and 8
31	31	(ii) Is typically administered: 9
32	32	(A) By a health care provider authorized under the laws of this state to administer the drug, 10
33	33	including when acting under a physician's delegation and supervision; and 11
34	34	(B) In a physician's office, hospital outpatient infusion center, or other clinical setting. 12
35	35	(b) A health benefit issuer or pharmacy benefit manager: 13
36	36	(1) Shall not refuse to authorize, approve, or pay a participating provider for providing 14
37	37	covered clinician-administered drugs and related services to covered persons; 15
38	38	(2) Shall not impose coverage or benefits limitations, or require an enrollee to pay an 16
39	39	additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or other 17
40	40	penalty when obtaining clinician-administered drugs from a health care provider authorized under 18
41	41	the laws of this state to administer clinician-administered drugs, or a pharmacy; 19
42	42
43	43
44	44	LC002496 - Page 2 of 8
45	45	(3) Shall not interfere with the patient's right to choose to obtain a clinician-administered 1
46	46	drug from their provider or pharmacy of choice, including inducement, steering, or offering 2
47	47	financial or other incentives; 3
48	48	(4) Shall not require clinician-administered drugs to be dispensed by a pharmacy selected 4
49	49	by the health plan or create such a requirement through contract with a third party, including, but 5
50	50	not limited to, a pharmacy benefit manager; 6
51	51	(5) Shall not limit or exclude coverage for a clinician-administered drug when not 7
52	52	dispensed by a pharmacy selected by the health plan, if the drug would otherwise be covered; 8
53	53	(6) Shall not reimburse at a lesser amount clinician-administered drugs dispensed by a 9
54	54	pharmacy not selected by the health plan or create such an arrangement through contract with a 10
55	55	third party, including, but not limited to, a pharmacy benefit manager; 11
56	56	(7) Shall not condition, deny, restrict, refuse to authorize or approve, or reduce payment to 12
57	57	a participating provider for providing covered clinician-administered drugs and related services to 13
58	58	covered persons when all criteria for medical necessity are met, because the participating provider 14
59	59	obtains clinician-administered drugs from a pharmacy that is not a participating provider in the 15
60	60	health benefit issuer's network; 16
61	61	(8) Shall not require that an enrollee pay an additional fee, higher copay, higher 17
62	62	coinsurance, second copay, second coinsurance, or any other form of price increase for clinician-18
63	63	administered drugs when not dispensed by a pharmacy selected by the health plan or create such a 19
64	64	requirement through contract with a third party, including, but not limited to, a pharmacy benefit 20
65	65	manager; 21
66	66	(9) Shall not require a specialty pharmacy to dispense a clinician-administered medication 22
67	67	directly to a patient with the intention that the patient will transport the medication to a healthcare 23
68	68	provider for administration. 24
69	69	(c) A health benefit issuer may offer, but shall not require, either directly or through 25
70	70	contract with a third party, including, but not limited to, a pharmacy benefit manager: 26
71	71	(1) The use of a home infusion pharmacy to dispense clinician-administered drugs to 27
72	72	patients in their homes or; 28
73	73	(2) The use of an infusion site external to a patient's provider office or clinic. 29
74	74	SECTION 2. Chapter 27-19 of the General Laws entitled "Nonprofit Hospital Service 30
75	75	Corporations" is hereby amended by adding thereto the following section: 31
76	76	27-19-26.3. Patient choice in dispensing of clinician-administered drugs. 32
77	77	(a) As used in this section: 33
78	78	(1) "Clinician-administered drug" means an outpatient prescription drug other than a 34
79	79
80	80
81	81	LC002496 - Page 3 of 8
82	82	vaccine that: 1
83	83	(i) Cannot reasonably be self-administered by the patient to whom the drug is prescribed 2
84	84	or by an individual assisting the patient with the self-administration; and 3
85	85	(ii) Is typically administered: 4
86	86	(A) By a health care provider authorized under the laws of this state to administer the drug, 5
87	87	including when acting under a physician's delegation and supervision; and 6
88	88	(B) In a physician's office, hospital outpatient infusion center, or other clinical setting. 7
89	89	(b) A health benefit issuer or pharmacy benefit manager: 8
90	90	(1) Shall not refuse to authorize, approve, or pay a participating provider for providing 9
91	91	covered clinician-administered drugs and related services to covered persons; 10
92	92	(2) Shall not impose coverage or benefits limitations, or require an enrollee to pay an 11
93	93	additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or other 12
94	94	penalty when obtaining clinician-administered drugs from a health care provider authorized under 13
95	95	the laws of this state to administer clinician-administered drugs, or a pharmacy; 14
96	96	(3) Shall not interfere with the patient's right to choose to obtain a clinician-administered 15
97	97	drug from their provider or pharmacy of choice, including inducement, steering, or offering 16
98	98	financial or other incentives; 17
99	99	(4) Shall not require clinician-administered drugs to be dispensed by a pharmacy selected 18
100	100	by the health plan or create such a requirement through contract with a third party, including, but 19
101	101	not limited to, a pharmacy benefit manager; 20
102	102	(5) Shall not limit or exclude coverage for a clinician-administered drug when not 21
103	103	dispensed by a pharmacy selected by the health plan, if the drug would otherwise be covered; 22
104	104	(6) Shall not reimburse at a lesser amount clinician-administered drugs dispensed by a 23
105	105	pharmacy not selected by the health plan or create such an arrangement through contract with a 24
106	106	third party, including, but not limited to, a pharmacy benefit manager; 25
107	107	(7) Shall not condition, deny, restrict, refuse to authorize or approve, or reduce payment to 26
108	108	a participating provider for providing covered clinician-administered drugs and related services to 27
109	109	covered persons when all criteria for medical necessity are met, because the participating provider 28
110	110	obtains clinician-administered drugs from a pharmacy that is not a participating provider in the 29
111	111	health benefit issuer's network; 30
112	112	(8) Shall not require that an enrollee pay an additional fee, higher copay, higher 31
113	113	coinsurance, second copay, second coinsurance, or any other form of price increase for clinician-32
114	114	administered drugs when not dispensed by a pharmacy selected by the health plan or create such a 33
115	115	requirement through contract with a third party, including, but not limited to, a pharmacy benefit 34
116	116
117	117
118	118	LC002496 - Page 4 of 8
119	119	manager; 1
120	120	(9) Shall not require a specialty pharmacy to dispense a clinician-administered medication 2
121	121	directly to a patient with the intention that the patient will transport the medication to a healthcare 3
122	122	provider for administration. 4
123	123	(c) A health benefit issuer may offer, but shall not require, either directly or through 5
124	124	contract with a third party, including, but not limited to, a pharmacy benefit manager: 6
125	125	(1) The use of a home infusion pharmacy to dispense clinician-administered drugs to 7
126	126	patients in their homes or; 8
127	127	(2) The use of an infusion site external to a patient's provider office or clinic. 9
128	128	SECTION 3. Chapter 27-20 of the General Laws entitled "Nonprofit Medical Service 10
129	129	Corporations" is hereby amended by adding thereto the following section: 11
130	130	27-20-23.3. Patient choice in dispensing of clinician-administered drugs. 12
131	131	(a) As used in this section: 13
132	132	(1) "Clinician-administered drug" means an outpatient prescription drug other than a 14
133	133	vaccine that: 15
134	134	(i) Cannot reasonably be self-administered by the patient to whom the drug is prescribed 16
135	135	or by an individual assisting the patient with the self-administration; and 17
136	136	(ii) Is typically administered: 18
137	137	(A) By a health care provider authorized under the laws of this state to administer the drug, 19
138	138	including when acting under a physician's delegation and supervision; and 20
139	139	(B) In a physician's office, hospital outpatient infusion center, or other clinical setting. 21
140	140	(b) A health benefit issuer or pharmacy benefit manager: 22
141	141	(1) Shall not refuse to authorize, approve, or pay a participating provider for providing 23
142	142	covered clinician-administered drugs and related services to covered persons; 24
143	143	(2) Shall not impose coverage or benefits limitations, or require an enrollee to pay an 25
144	144	additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or other 26
145	145	penalty when obtaining clinician-administered drugs from a health care provider authorized under 27
146	146	the laws of this state to administer clinician-administered drugs, or a pharmacy; 28
147	147	(3) Shall not interfere with the patient's right to choose to obtain a clinician-administered 29
148	148	drug from their provider or pharmacy of choice, including inducement, steering, or offering 30
149	149	financial or other incentives; 31
150	150	(4) Shall not require clinician-administered drugs to be dispensed by a pharmacy selected 32
151	151	by the health plan or create such a requirement through contract with a third party, including, but 33
152	152	not limited to, a pharmacy benefit manager; 34
153	153
154	154
155	155	LC002496 - Page 5 of 8
156	156	(5) Shall not limit or exclude coverage for a clinician-administered drug when not 1
157	157	dispensed by a pharmacy selected by the health plan, if the drug would otherwise be covered; 2
158	158	(6) Shall not reimburse at a lesser amount clinician-administered drugs dispensed by a 3
159	159	pharmacy not selected by the health plan or create such an arrangement through contract with a 4
160	160	third party, including, but not limited to, a pharmacy benefit manager; 5
161	161	(7) Shall not condition, deny, restrict, refuse to authorize or approve, or reduce payment to 6
162	162	a participating provider for providing covered clinician-administered drugs and related services to 7
163	163	covered persons when all criteria for medical necessity are met, because the participating provider 8
164	164	obtains clinician-administered drugs from a pharmacy that is not a participating provider in the 9
165	165	health benefit issuer's network; 10
166	166	(8) Shall not require that an enrollee pay an additional fee, higher copay, higher 11
167	167	coinsurance, second copay, second coinsurance, or any other form of price increase for clinician-12
168	168	administered drugs when not dispensed by a pharmacy selected by the health plan or create such a 13
169	169	requirement through contract with a third party, including, but not limited to, a pharmacy benefit 14
170	170	manager; 15
171	171	(9) Shall not require a specialty pharmacy to dispense a clinician-administered medication 16
172	172	directly to a patient with the intention that the patient will transport the medication to a healthcare 17
173	173	provider for administration. 18
174	174	(c) A health benefit issuer may offer, but shall not require, either directly or through 19
175	175	contract with a third party, including, but not limited to, a pharmacy benefit manager: 20
176	176	(1) The use of a home infusion pharmacy to dispense clinician-administered drugs to 21
177	177	patients in their homes or; 22
178	178	(2) The use of an infusion site external to a patient's provider office or clinic. 23
179	179	SECTION 4. Chapter 27-41 of the General Laws entitled "Health Maintenance 24
180	180	Organizations" is hereby amended by adding thereto the following section: 25
181	181	27-41-38.3. Patient choice in dispensing of clinician-administered drugs. 26
182	182	(a) As used in this section: 27
183	183	(1) "Clinician-administered drug" means an outpatient prescription drug other than a 28
184	184	vaccine that: 29
185	185	(i) Cannot reasonably be self-administered by the patient to whom the drug is prescribed 30
186	186	or by an individual assisting the patient with the self-administration; and 31
187	187	(ii) Is typically administered: 32
188	188	(A) By a health care provider authorized under the laws of this state to administer the drug, 33
189	189	including when acting under a physician's delegation and supervision; and 34
190	190
191	191
192	192	LC002496 - Page 6 of 8
193	193	(B) In a physician's office, hospital outpatient infusion center, or other clinical setting. 1
194	194	(b) A health benefit issuer or pharmacy benefit manager: 2
195	195	(1) Shall not refuse to authorize, approve, or pay a participating provider for providing 3
196	196	covered clinician-administered drugs and related services to covered persons; 4
197	197	(2) Shall not impose coverage or benefits limitations, or require an enrollee to pay an 5
198	198	additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or other 6
199	199	penalty when obtaining clinician-administered drugs from a health care provider authorized under 7
200	200	the laws of this state to administer clinician-administered drugs, or a pharmacy; 8
201	201	(3) Shall not interfere with the patient's right to choose to obtain a clinician-administered 9
202	202	drug from their provider or pharmacy of choice, including inducement, steering, or offering 10
203	203	financial or other incentives; 11
204	204	(4) Shall not require clinician-administered drugs to be dispensed by a pharmacy selected 12
205	205	by the health plan or create such a requirement through contract with a third party, including, but 13
206	206	not limited to, a pharmacy benefit manager; 14
207	207	(5) Shall not limit or exclude coverage for a clinician-administered drug when not 15
208	208	dispensed by a pharmacy selected by the health plan, if the drug would otherwise be covered; 16
209	209	(6) Shall not reimburse at a lesser amount clinician-administered drugs dispensed by a 17
210	210	pharmacy not selected by the health plan or create such an arrangement through contract with a 18
211	211	third party, including, but not limited to, a pharmacy benefit manager; 19
212	212	(7) Shall not condition, deny, restrict, refuse to authorize or approve, or reduce payment to 20
213	213	a participating provider for providing covered clinician-administered drugs and related services to 21
214	214	covered persons when all criteria for medical necessity are met, because the participating provider 22
215	215	obtains clinician-administered drugs from a pharmacy that is not a participating provider in the 23
216	216	health benefit issuer's network; 24
217	217	(8) Shall not require that an enrollee pay an additional fee, higher copay, higher 25
218	218	coinsurance, second copay, second coinsurance, or any other form of price increase for clinician-26
219	219	administered drugs when not dispensed by a pharmacy selected by the health plan or create such a 27
220	220	requirement through contract with a third party, including, but not limited to, a pharmacy benefit 28
221	221	manager; 29
222	222	(9) Shall not require a specialty pharmacy to dispense a clinician-administered medication 30
223	223	directly to a patient with the intention that the patient will transport the medication to a healthcare 31
224	224	provider for administration. 32
225	225	(c) A health benefit issuer may offer, but shall not require, either directly or through 33
226	226	contract with a third party, including, but not limited to, a pharmacy benefit manager: 34
227	227
228	228
229	229	LC002496 - Page 7 of 8
230	230	(1) The use of a home infusion pharmacy to dispense clinician-administered drugs to 1
231	231	patients in their homes or; 2
232	232	(2) The use of an infusion site external to a patient's provider office or clinic. 3
233	233	SECTION 5. This act shall take effect upon passage. 4
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235	235	LC002496
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238	238
239	239	LC002496 - Page 8 of 8
240	240	EXPLANATION
241	241	BY THE LEGISLATIVE COUNCIL
242	242	OF
243	243	A N A C T
244	244	RELATING TO INSURANCE -- ACCIDENT AND SICKNESS INSURANCE POLICIES
245	245	***
246	246	This act would prevent healthcare entities from refusing to authorize, approve, or pay a 1
247	247	participating provider for providing covered clinician-administered drugs and related services to 2
248	248	covered persons. This act would also prevent healthcare entities from imposing coverage or benefits 3
249	249	limitations, or require an enrollee to pay an additional fee, higher copay, higher coinsurance, second 4
250	250	copay, second coinsurance, or other penalty when obtaining clinician-administered drugs from a 5
251	251	health care provider. It would prohibit interference with the patient's right to choose to obtain a 6
252	252	clinician-administered drug from their provider or pharmacy of choice. 7
253	253	This act would take effect upon passage. 8
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255	255	LC002496
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257	257