(1)A specialty pharmacy that ships a clinician-administered drug to a health care provider or pharmacy shall:
(a)Comply with all federal laws regulating the shipment of drugs, including, but not limited to, general chapter 800 of the United States Pharmacopeia;
(b)In response to questions from a health care provider or pharmacy, provide access to a pharmacist or nurse employed by the specialty pharmacy twenty-four hours per day, seven days per week;
(c)Allow a covered person and health care provider to request a refill of a clinician-administered drug on behalf of a covered person in accordance with the pharmacy benefit manager's or health carrier's utilization review procedures; and
(d)Adhere to the track and trace requirements, as described in the federal Drug Supply Chain Security
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(1) A specialty pharmacy that ships a clinician-administered drug to a health care provider or pharmacy shall:
(a) Comply with all federal laws regulating the shipment of drugs, including, but not limited to, general chapter 800 of the United States Pharmacopeia;
(b) In response to questions from a health care provider or pharmacy, provide access to a pharmacist or nurse employed by the specialty pharmacy twenty-four hours per day, seven days per week;
(c) Allow a covered person and health care provider to request a refill of a clinician-administered drug on behalf of a covered person in accordance with the pharmacy benefit manager's or health carrier's utilization review procedures; and
(d) Adhere to the track and trace requirements, as described in the federal Drug Supply Chain Security Act, 21 U.S.C. 360eee et seq., for a clinician-administered drug that needs to be compounded or manipulated and, if requested by the health care provider or the provider's designee, provide the track and trace information to the health care provider or designee.
(2) For any clinician-administered drug dispensed by a specialty pharmacy selected by the pharmacy benefit manager or health carrier, the requesting health care provider or the provider's designee shall provide the requested date, approximate time, and place of delivery of a clinician-administered drug at least five business days before the date of delivery. The specialty pharmacy shall require a signature of the health care provider or the provider's designee upon receipt of the shipment when shipped to a health care provider. If any clinician-administered drug dispensed by a specialty pharmacy is not delivered as specified in this subsection, the covered person shall not be financially responsible if the clinician-administered drug is not able to be administered to the covered person.
(3) The requirements of subsections (1) and (2) of this section do not apply when the specialty pharmacy and the health care provider administering the clinician-administered drug have shared ownership.
(4) A pharmacy benefit manager or health carrier that requires dispensing of a clinician-administered drug through a specialty pharmacy shall establish and disclose a process which allows the health care provider or pharmacy to appeal and have exceptions to the use of a specialty pharmacy when:
(a) A drug is not delivered as specified in subsection (2) of this section; or
(b) An attending health care provider reasonably believes a covered person may experience harm without the immediate use of a clinician-administered drug that a health care provider or pharmacy has in stock.
(5) A pharmacy benefit manager or health carrier shall not:
(a) Require a specialty pharmacy to dispense a covered clinician-administered drug directly to a covered person with the intention that the covered person will transport the clinician-administered drug to a health care provider for administration;
(b) Refuse to authorize or reimburse a participating provider for dispensing a covered clinician-administered drug based on costs if the costs of the drug to the health benefit plan are substantially similar as compared to the costs of the drug if provided from a specialty pharmacy selected by the pharmacy benefit manager or health carrier;
(c) Refuse to authorize or reimburse a participating provider pursuant to the network agreement for the administration of covered clinician-administered drugs;
(d) Penalize or remove from the network a participating provider solely for refusing to administer a covered clinician-administered drug received from a specialty pharmacy selected by the pharmacy benefit manager or health carrier. If a participating provider refuses to source covered clinician-administered drugs from a specialty pharmacy selected by the pharmacy benefit manager or health carrier, the participating provider shall direct the covered person to contact the health carrier for coverage options; or
(e) Require a covered person to obtain a clinician-administered drug from a specialty pharmacy selected by the pharmacy benefit manager or health carrier if a participating provider of the covered person's choice sources the drug and provides for administration at substantially similar costs.