{"AmendmentNumber":"21","ParentBillNumber":"S3141","Bill":null,"Sponsor":{"Id":"L_S1","Name":"Lindsay N. Sabadosa","Type":1,"Details":"https://malegislature.gov/api/GeneralCourts/194/LegislativeMembers/L_S1","ResponseDate":"2026-07-29T12:09:32.467"},"Category":null,"Action":null,"RollCall":[],"Title":"Patient Choice in Dispensing of Clinician-Administered Drugs","Branch":"House","RedraftNumber":null,"IsFurther":false,"GeneralCourtNumber":194,"Text":"Ms. Sabadosa of Northampton moves to amend the bill by adding the following section: \r\nSECTION XXX. Chapter 176O of the General Laws is hereby amended by inserting after section 30 the following section:-\r\nSection 31. (a) In this section:\r\n(1) \"Clinician-administered drug\" means an outpatient prescription drug other than a vaccine that:\r\n(A) cannot reasonably be self-administered by the patient to whom the drug is prescribed or by an individual assisting the patient with the self-administration; and\r\n(B) is typically administered:\r\n(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\r\n(ii) in a physician’s office, hospital outpatient infusion center, or other clinical setting.\r\n(b) A health benefit carrier:\r\n(1) shall not refuse to authorize, approve, or pay a participating provider for providing covered clinician-administered drugs and related services to covered persons;\r\n(2) shall not impose coverage or benefits 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;\r\n(3) shall not interfere with the patient's right to choose to obtain a clinician-administered drug from their provider or pharmacy of choice, including inducement, steering, or offering financial or other incentives;\r\n(4) shall not require clinician-administered drugs to be dispensed by a pharmacy selected by the health plan;\r\n(5) shall not limit or exclude coverage for a clinician-administered drug when not dispensed by a pharmacy selected by the health plan, if such drug would otherwise be covered;\r\n(6) shall not reimburse at a lesser amount clinician-administered drugs dispensed by a pharmacy not selected by the health plan;\r\n(7) shall not 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 all criteria for medical necessity are met, because the participating provider obtains clinician-administered drugs from a pharmacy that is not a participating provider in the health benefit issuer’s network;\r\n(8) shall not 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 plan;\r\n(9) shall not 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 healthcare provider for administration\r\n(c) A health benefit carrier may offer, but shall not require:\r\n(1) the use of a home infusion pharmacy to dispense clinician-administered drugs to patients in their homes or;\r\n(2) the use of an infusion site external to a patient’s provider office or clinic.\r\n"}