Budget Amendment ID: FY2016-S3-935

EHS 935

Review of Specialty Drug Dispensing and Patient Safety

Messrs. Keenan and Brownsberger, Ms. Gobi, Mr. Ross, Ms. Donoghue, Ms. O'Connor Ives, Mrs. L'Italien, Messrs. Montigny and Moore and Ms. Creem moved that the proposed new text be amended by inserting the following new section:-

SECTION __. The Secretary for Health and Human Services, in coordination with the Department of Public Health and the Division of Insurance, shall conduct a review of carrier practices which require certain categories of drugs, including those that are administered by injection or infusion, to be dispensed by a third-party specialty pharmacy directly to a patient or to a provider with the designation that such drugs be used for a specific patient and not for the general use of the provider.  The secretary shall make recommendations to the General Court for the regulation or restriction of said practice as appropriate and if necessary to ensure patient safety and to meet reasonable cost containment goals, which may include recommendations for statutory changes.

Notwithstanding any General or special law to the contrary, until such recommendations are filed, or until July 1st 2016, whichever occurs earlier, no insurance carrier shall require that a cancer-related or chronic-illness related drug be purchased and delivered to a patient, to a patient’s guardian or representative, or to a patient’s chosen provider only through a third-party specialty pharmacy; provided, however, that nothing in this section shall prohibit a patient or provider, including a home health agency or hospice, from choosing to receive such drugs from a third-party specialty pharmacy. For the purposes of this section the terms “cancer-related drug” and “chronic-illness related drug” shall mean a controlled substance that is indicated for the treatment of cancer or another chronic illness, or for managing the side effects of such treatment, and that must be administered by injection in a clinic, hospital, or physician’s office and which the patient’s treating healthcare provider has determined cannot be reasonably self-administered by a patient to whom the drug is prescribed or by an individual assisting the patient with self-administration; and the term “carrier” shall include those  defined in section 1 of chapter 176O as well as health plans that are under contract to the  group insurance commission established under Chapter 32A of the General Laws.