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REFERENCE TITLE: prescription drug coverage; limitations |
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State of Arizona House of Representatives Fifty-fifth Legislature Second Regular Session 2022
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HB 2569 |
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Introduced by Representative Wilmeth
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AN ACT
amending title 20, chapter 25, article 2, arizona revised statutes, by adding section 20-3333; relating to pharmacy benefit managers.
(TEXT OF BILL BEGINS ON NEXT PAGE)
Be it enacted by the Legislature of the State of Arizona:
Section 1. Title 20, chapter 25, article 2, Arizona Revised Statutes, is amended by adding section 20-3333, to read:
20-3333. Clinician-administered drugs; limitations; definitions
A. A pharmacy benefit manager, health insurer or third-party payor may not:
1. Require a clinician-administered drug to be dispensed by a pharmacy, including by an affiliated provider, as a condition of coverage.
2. Limit or exclude coverage for a clinician-administered drug or prescription drug that is not dispensed by a pharmacy or affiliated provider, if the prescription drug is otherwise covered under the health benefits plan or pharmacy benefit plan.
3. Cover a prescription drug as a different benefit or tier or with cost sharing requirements that impose greater expense for a covered individual if the drug is dispensed or administered at the prescriber's office, a hospital outpatient infusion center or any other outpatient clinical setting rather than a pharmacy or affiliated provider.
B. This section does not do either of the following:
1. Authorize a person to administer a prescription drug that is otherwise prohibited under the laws of this state or federal law.
2. Modify prescription drug administration requirements under the laws of this state, including any requirements related to delegating and supervising prescription drug administration.
C. For the purposes of this section:
1. "Affiliated provider" means a pharmacy or durable medical equipment provider that directly, or indirectly through one or more intermediaries, controls, is controlled by or is under common control with a pharmacy benefit manager.
2. "Clinician-Administered Drug" means an outpatient prescription drug that cannot reasonably be self-administered by the patient to whom the drug is prescribed and that is typically administered by a health care provider authorized under the laws of this state to administer the drug.
3. "Health Care Provider" means an individual who is licensed, certified or otherwise authorized to provide health care services in this state.
4. "Prescriber" means an individual who is licensed to prescribe prescription drugs in this state.
Sec. 2. Applicability
Section 20-3333, Arizona Revised Statutes, as added by this act, applies to contracts entered into, amended, extended or renewed on or after the effective date of this act.