1 New Subdivision; Managed Care Law; Clinician-Administered Drugs. Amend RSA 420-J by inserting after section 26 the following new subdivision:

Clinician-Administered Drugs

420-J:27 Definition of Clinician-Administered Drug. In this subdivision, "clinician-administered drug" means an outpatient prescription drug, other than a vaccine, that:

I. Cannot reasonably be self-administered by the patient to whom the drug is prescribed or by an individual assisting the enrollee with self-administration; and

II. Is typically administered:

(a) 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

(b) In a physician's office, hospital outpatient infusion center, or other clinical setting.

420-J:28 Safety, Care, and Choice Requirements for Clinician-Administered Drugs.

I. No health insurer or pharmacy benefit manager shall mandate that a clinician-administered drug be dispensed by a pharmacy selected by the insurer or PBM and delivered to a provider for administration ("white bagging"), unless:

(a) There is a written agreement between the provider and the dispensing pharmacy outlining responsibilities for each party including, but not limited to, procedures for delivery, handling, storage, and liability; and

(b) The provider has given prior written consent to use that arrangement.

II. No health insurer or pharmacy benefit manager shall mandate that a pharmacy dispense a clinician-administered drug to a patient for transport to a health care provider for administration ("brown bagging"), unless:

(a) There is a written attestation from the patient and provider that transporting the medication will not compromise care.

(b) The patient and provider have given prior written consent to use that arrangement.

III. Pursuant to paragraphs I and II, a health carrier or pharmacy benefit manager shall not:

(a) Interfere with the enrollee's right to choose to obtain a clinician-administered drug from their provider or pharmacy of choice.

(b) Limit or exclude coverage for a clinician-administered drug when not dispensed by a pharmacy selected by the health carrier, if such drug would otherwise be covered.

(c) Require that an enrollee pay an additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or any other form of price increase for clinician-administered drugs when not dispensed by a pharmacy selected by the health carrier or pharmacy benefit manager.

(d) Condition, deny, restrict, refuse to authorize or approve, or reduce payment to a participating health care provider for providing covered clinician-administered drugs and related services to covered persons when all criteria for medical necessity are met, because the participating health care provider obtains clinician-administered drugs from a pharmacy that is not a participating provider in the health carrier's network or managed or owned by the pharmacy benefit manager.

2 Effective Date. This act shall take effect January 1, 2027.

1 New Subdivision; Managed Care Law; Clinician-Administered Drugs. Amend RSA 420-J by inserting after section 26 the following new subdivision:

Clinician-Administered Drugs

420-J:27 Definition of Clinician-Administered Drug. In this subdivision, "clinician-administered drug" means an outpatient prescription drug, other than a vaccine, that:

I. Cannot reasonably be self-administered by the patient to whom the drug is prescribed or by an individual assisting the enrollee with self-administration; and

II. Is typically administered:

(a) 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

(b) In a physician's office, hospital outpatient infusion center, or other clinical setting.

420-J:28 Safety, Care, and Choice Requirements for Clinician-Administered Drugs.

I. No health insurer or pharmacy benefit manager shall mandate that a clinician-administered drug be dispensed by a pharmacy selected by the insurer or PBM and delivered to a provider for administration ("white bagging"), unless:

(a) There is a written agreement between the provider and the dispensing pharmacy outlining responsibilities for each party including, but not limited to, procedures for delivery, handling, storage, and liability; and

(b) The provider has given prior written consent to use that arrangement.

II. No health insurer or pharmacy benefit manager shall mandate that a pharmacy dispense a clinician-administered drug to a patient for transport to a health care provider for administration ("brown bagging"), unless:

(a) There is a written attestation from the patient and provider that transporting the medication will not compromise care.

(b) The patient and provider have given prior written consent to use that arrangement.

III. Pursuant to paragraphs I and II, a health carrier or pharmacy benefit manager shall not:

(a) Interfere with the enrollee's right to choose to obtain a clinician-administered drug from their provider or pharmacy of choice.

(b) Limit or exclude coverage for a clinician-administered drug when not dispensed by a pharmacy selected by the health carrier, if such drug would otherwise be covered.

(c) Require that an enrollee pay an additional fee, higher copay, higher coinsurance, second copay, second coinsurance, or any other form of price increase for clinician-administered drugs when not dispensed by a pharmacy selected by the health carrier or pharmacy benefit manager.

(d) Condition, deny, restrict, refuse to authorize or approve, or reduce payment to a participating health care provider for providing covered clinician-administered drugs and related services to covered persons when all criteria for medical necessity are met, because the participating health care provider obtains clinician-administered drugs from a pharmacy that is not a participating provider in the health carrier's network or managed or owned by the pharmacy benefit manager.

2 Effective Date. This act shall take effect January 1, 2027.