Florida Senate - 2022                                     SB 748
       
       
        
       By Senator Diaz
       
       
       
       
       
       36-00696-22                                            2022748__
    1                        A bill to be entitled                      
    2         An act relating to clinician-administered drugs;
    3         creating s. 627.42398, F.S.; defining terms;
    4         prohibiting specified insurer practices related to
    5         reimbursements, payment, access, dispensing, or
    6         coverage of clinician-administered drugs; providing an
    7         effective date.
    8          
    9  Be It Enacted by the Legislature of the State of Florida:
   10  
   11         Section 1. Section 627.42398, Florida Statutes, is created
   12  to read:
   13         627.42398 Clinician-administered drugs.—
   14         (1) As used in this section, the term:
   15         (a) “Administer” or “administration” means to directly
   16  introduce a drug into the body of a patient by injection,
   17  inhalation, ingestion, or any other means.
   18         (b) “Clinician-administered drug” means a prescription drug
   19  other than a vaccine which is typically administered by a health
   20  care provider in a health care facility and cannot reasonably or
   21  effectively be self-administered by a patient or administered by
   22  a person other than a health care provider.
   23         (c) “Dispense” means the transfer of possession of a
   24  clinician-administered drug pursuant to a lawful prescription.
   25         (d) “Health care facility“ means an ambulatory surgical
   26  center or hospital licensed under chapter 395, an alcohol or
   27  chemical dependency treatment center licensed under chapter 397,
   28  an inpatient hospice licensed under part IV of chapter 400, a
   29  nursing home licensed under part II of chapter 400, an
   30  ambulatory care center as defined in s. 408.07, an assisted
   31  living facility licensed under part I of chapter 429, or a
   32  nursing home component under chapter 400 within a continuing
   33  care facility licensed under chapter 651.
   34         (e) “Health care provider” means any individual authorized
   35  by law to administer prescription drugs in this state, including
   36  providers acting under another provider’s delegation and
   37  supervision.
   38         (f) “Insurer” means an insurer as defined in s. 624.03, a
   39  self-insurance plan as defined in s. 624.031, a multiple
   40  employer welfare arrangement as defined in s. 624.437, a
   41  fraternal benefit society as defined in s. 632.601, a prepaid
   42  limited health service organization as defined in s. 636.003, a
   43  health maintenance organization as defined in s. 641.19, a
   44  prepaid health clinic as defined in s. 641.402, or any health
   45  care arrangement whereby risk is assumed.
   46         (g) “Patient-to-provider dispensing” means the practice by
   47  which a patient is dispensed a clinician-administered drug from
   48  the patient’s chosen pharmacy and then transports the drug to a
   49  health care provider for administration.
   50         (h) “Unrelated pharmacy” means a pharmacy that is not
   51  affiliated with, managed by, controlled by, or contracted
   52  directly with a health care facility.
   53         (i) “Unrelated pharmacy dispensing” means the practice by
   54  which an unrelated pharmacy dispenses a clinician-administered
   55  drug directly to a health care facility for administration to a
   56  patient by a health care provider.
   57         (2) An insurer may not do any of the following:
   58         (a) Reimburse a health care facility or provider for the
   59  administration of a clinician-administered drug obtained through
   60  patient-to-provider dispensing.
   61         (b) Except as provided in paragraph (a), refuse to
   62  authorize, approve, or pay a participating provider for
   63  providing covered clinician-administered drugs and related
   64  services to covered persons.
   65         (c) Interfere with the patient’s right to choose to obtain
   66  a clinician-administered drug from the patient’s chosen health
   67  care provider, health care facility, third-party drug
   68  distributor or pharmacy by any means, including, but not limited
   69  to, inducement, steering, or offering financial or other
   70  incentives.
   71         (d) Require clinician-administered drugs to be dispensed by
   72  a pharmacy selected by the insurer.
   73         (e) Limit or exclude coverage for a clinician-administered
   74  drug if it was not dispensed by a pharmacy selected by the
   75  insurer, if such drug would otherwise be covered.
   76         (f) Reimburse at a lesser amount clinician-administered
   77  drugs dispensed by a pharmacy that was not selected by the
   78  insurer.
   79         (g) Condition, deny, restrict, refuse to authorize or
   80  approve, or reduce payment to a health care provider or health
   81  care facility for providing covered clinician-administered drugs
   82  and related services to covered persons if all criteria for
   83  medical necessity are met, solely on the basis that the health
   84  care provider or health care facility obtains clinician
   85  administered drugs from a pharmacy that has not entered into a
   86  written agreement with the patient’s insurer to provide medical
   87  or pharmacy benefits.
   88         (h) Impose coverage or benefits limitations; require that
   89  an enrollee pay an additional fee, higher copay, higher
   90  coinsurance, second copay, second coinsurance; or impose any
   91  other form of price increase for clinician-administered drugs if
   92  they are not dispensed by a pharmacy selected by the insurer.
   93         (i) Require an unrelated pharmacy dispensing process for
   94  clinician-administered drugs.
   95         Section 2. This act shall take effect July 1, 2022.