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1 New Section; Health Maintenance Organizations; Dispensing of Clinician-Administered Drugs. Amend RSA 420-B by inserting after section 26 the following new section:
420-B:27 Dispensing of Clinician-Administered Drugs.
I. As used in this section, "clinician-administered drug" means an outpatient prescription drug other than a vaccine that:
(a) Cannot reasonably be self-administered by the patient to whom the drug is prescribed or by a non-clinician individual assisting the patient with the self-administration; and
(b) Is typically administered:
(1) By a health care professional authorized under the laws of this state to administer the drug, including when acting under a physician's delegation and supervision; and
(2) In a physician's office, hospital outpatient infusion center, or other clinical setting.
II. A health maintenance organization or a third party acting on its behalf shall not refuse to authorize, approve, or pay a provider for a covered clinician-administered drug that was dispensed by any in-network hospital or clinic, provided that:
(a) According to medical standards of care for the patient's condition, the medication must be provided to the patient more expeditiously than the medication could be provided via any other channel covered by the insurer; and
(b) The dispensing and any associated authorization, approval, or payment occurs consistent with the terms and conditions of similarly situated network participants and according to the benefit offered by the health maintenance organization.
III. Unless otherwise requested in writing by the patient or prescriber, a health maintenance organization, pharmacy benefits manager, or other third party acting on behalf of the health maintenance organization, shall not, by contract, written policy, or written procedure, require that a pharmacy dispense a clinician-administered drug directly to a patient with the expectation or intention that the patient will transport the medication to a health care setting for administration by a health care professional.
2 Effective Date. This act shall take effect January 1, 2024.
Text to be added highlighted in green.
1 New Section; Health Maintenance Organizations; Dispensing of Clinician-Administered Drugs. Amend RSA 420-B by inserting after section 26 the following new section:
420-B:27 Dispensing of Clinician-Administered Drugs.
I. As used in this section, "clinician-administered drug" means an outpatient prescription drug other than a vaccine that:
(a) Cannot reasonably be self-administered by the patient to whom the drug is prescribed or by a non-clinician individual assisting the patient with the self-administration; and
(b) Is typically administered:
(1) By a health care professional authorized under the laws of this state to administer the drug, including when acting under a physician's delegation and supervision; and
(2) In a physician's office, hospital outpatient infusion center, or other clinical setting.
II. A health maintenance organization or a third party acting on its behalf shall not refuse to authorize, approve, or pay a provider for a covered clinician-administered drug that was dispensed by any in-network hospital or clinic, provided that:
(a) According to medical standards of care for the patient's condition, the medication must be provided to the patient more expeditiously than the medication could be provided via any other channel covered by the insurer; and
(b) The dispensing and any associated authorization, approval, or payment occurs consistent with the terms and conditions of similarly situated network participants and according to the benefit offered by the health maintenance organization.
III. Unless otherwise requested in writing by the patient or prescriber, a health maintenance organization, pharmacy benefits manager, or other third party acting on behalf of the health maintenance organization, shall not, by contract, written policy, or written procedure, require that a pharmacy dispense a clinician-administered drug directly to a patient with the expectation or intention that the patient will transport the medication to a health care setting for administration by a health care professional.
2 Effective Date. This act shall take effect January 1, 2024.