Bill Summary – FastDemocracy

LB448                                                                      LB448
                                                                      2023
                              LEGISLATURE OF NEBRASKA
                          ONE HUNDRED EIGHTH LEGISLATURE
                                    FIRST SESSION
                       LEGISLATIVE BILL 448
        Introduced by Bostar, 29.
        Read first time January 13, 2023
        Committee: Banking, Commerce and Insurance
    A BILL FOR AN ACT relating to insurance; to prohibit certain provisions
        in a health plan in relation to clinician-administered drugs; and to
        define a term.
    Be it enacted by the people of the State of Nebraska,
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LB448                                                                                                  LB448
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         Section 1.        (1) Notwithstanding section 44-3,131, (a) any individual
    or group sickness and accident insurance policy,       certificate,       or
    subscriber contract delivered, issued for delivery, or renewed in this
    state and any hospital, medical, or surgical expense-incurred policy,
    except for policies that provide coverage for a specified disease or
    other limited-benefit coverage, and (b) any self-funded employee benefit
    plan to the extent not preempted by federal law, shall not:
         (a) Refuse to authorize, approve, or pay a participating provider
    for providing covered clinician-administered drugs and related services
    to covered persons;
         (b) Impose coverage or benefit limitations or require an enrollee to
    pay an additional fee, higher copay, higher coinsurance, second copay,
    second coinsurance,          or other penalty when obtaining clinician-
    administered drugs from a health care provider authorized under the laws
    of this state to administer clinician-administered drugs or a pharmacy;
         (c) Interfere with the right of a patient to choose to obtain a
    clinician-administered drug from such patient's provider such as through
    inducement, steering, or offering financial or other incentives;
         (d)     Require clinician-administered drugs to    be dispensed by   a
    pharmacy selected by the insurer;
         (e) Limit or exclude coverage for a clinician-administered drug when
    such drug is not dispensed by a pharmacy selected by the health plan if
    such drug would otherwise be covered;
         (f)     Reimburse at   a lesser amount    a clinician-administered drug
    dispensed by a pharmacy not selected by the insurer or acquired from an
    entity not selected by the insurer;
         (g) Condition, deny, restrict, refuse to authorize or approve, or
    reduce payment to    a participating provider for providing covered
    clinician-administered drugs and related services to covered persons when
    the participating provider obtains clinician-administered drugs from a
    wholesaler,     a distributor,       an entity,    or   a pharmacy that is    not    a
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LB448                                                                                                     LB448
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   participating provider in the insurer's network, if all criteria for
   medical necessity are met;
       (h) Require an enrollee to 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 insurer; or
        (i)     Require         a specialty pharmacy to   dispense     a clinician-
    administered medication directly to a patient with the intention that the
   patient will transport the medication to a health care provider for
   administration.
        (2) Notwithstanding section 44-3,131, (a) any individual or group
   sickness and accident insurance policy,    certificate,     or subscriber
   contract delivered, issued for delivery, or renewed in this state and any
    hospital,       medical,        or surgical expense-incurred policy,       except for
    policies that provide coverage for a specified disease or other limited-
    benefit coverage, and (b) any self-funded employee benefit plan to the
    extent not preempted by federal law, may offer, but shall not require:
        (i) The use of a home infusion pharmacy to dispense clinician-
    administered drugs to patients in their homes; or
        (ii) The use of an infusion site external to a patient's provider
    office or clinic.
        (3) For purposes of this section, clinician-administered drug means
    an outpatient prescription drug other than a vaccine that:
        (a) Cannot reasonably be self-administered to a patient by such
    patient or    by an       individual assisting the patient with the self-
    administration; and
        (b) Is typically administered:
       (i) By a health care provider authorized under the laws of this
    state to administer the drug, including when acting under a physician's
    delegation and supervision; and
       (ii) In a physician's office, hospital outpatient infusion center,
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LB448                                      LB448
                                      2023
   or other clinical setting.
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