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HB24-1010

Insurance Coverage for Provider-Administered Drugs

Concerning limitations on drugs covered under an individual's health insurance policy that are administered by a provider in a setting other than a hospital.
Session:
2024 Regular Session
Subject:
Health Care & Health Insurance
Bill Summary

For a covered person with a chronic, complex, rare, or life-threatening medical condition, the bill prohibits a carrier from:

  • Requiring a provider-administered drug to be dispensed only by certain pharmacies or only by a pharmacy participating in the carrier's network;
  • If a provider-administered drug is otherwise covered by the carrier for the covered person, limiting or excluding coverage for the drug based on the covered person's choice of pharmacy or because the drug was not dispensed by a pharmacy that participates in the carrier's network;
  • Requiring a participating provider to bill for or be reimbursed for the delivery and administration of a provider-administered drug under the pharmacy benefit instead of the medical benefit without informed, written consent of the covered person and written attestation by the covered person's participating provider that a delay in the drug's administration will not place the covered person at an increased health risk; or
  • Requiring a covered person to pay additional fees, copayments, or coinsurance based on the covered person's choice of pharmacy or because the provider-administered drug was not dispensed by a pharmacy that participates in the carrier's network.
    (Note: This summary applies to this bill as introduced.)

Status

Introduced
Under Consideration

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Bill Text

Sponsors

Sponsor Type Legislators
Prime Sponsor

Rep. I. Jodeh, Rep. M. Soper
Sen. D. Michaelson Jenet

Sponsor

Rep. A. Hartsook

Co-sponsor

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