This bill amends the Pharmacy Benefit Manager Licensure and Regulation Act by defining new terms and establishing requirements for clinician-administered drugs. Key insertions include the definitions of "clinician-administered drug," which refers to outpatient prescription drugs that cannot be self-administered and are typically administered by a healthcare provider in a clinical setting. Additionally, the bill introduces the term "specialty pharmacy," which specializes in dispensing drugs for patients with rare or complex medical conditions. The bill also outlines specific obligations for specialty pharmacies regarding the shipment of clinician-administered drugs, including compliance with federal laws, providing 24/7 access to pharmacists or nurses, and adhering to track and trace requirements.

Furthermore, the bill mandates that pharmacy benefit managers or health carriers must establish a process for healthcare providers to appeal the requirement to use a specialty pharmacy under certain circumstances, such as when a drug is not delivered as specified or when immediate use of a drug is necessary to prevent harm. The bill also prohibits requiring a specialty pharmacy to dispense a clinician-administered drug directly to a covered person for transport to a healthcare provider. The act is set to become operative on January 1, 2026, and repeals the original sections of the law that are being amended.

Statutes affected:
Introduced: 44-4601, 44-4603