Florida Senate - 2022 SB 748 By Senator Diaz 36-00696-22 2022748__ Page 1 of 4 CODING: Words stricken are deletions; words underlined are additions. A bill to be entitled 1

An act relating to clinician-administered drugs; 2 creating s. 627.42398, F.S.; defining terms; 3 prohibiting specified insurer practices related to 4 reimbursements, payment, access, dispensing, or 5 coverage of clinician-administered drugs; providing an 6 effective date. 7 8 Be It Enacted by the Legislature of the State of Florida: 9 10

Section

Section 627.42398, Florida Statutes, is created 11 to read: 12 627.42398 Clinician-administered drugs.— 13

(1) As used in this section, the term: 14 (a) “Administer” or “administration” means to directly 15 introduce a drug into the body of a patient by injection, 16 inhalation, ingestion, or any other means. 17 (b) “Clinician-administered drug” means a prescription drug 18 other than a vaccine which is typically administered by a health 19 care provider in a health care facility and cannot reasonably or 20 effectively be self-administered by a patient or administered by 21 a person other than a health care provider. 22 (c) “Dispense” means the transfer of possession of a 23 clinician-administered drug pursuant to a lawful prescription. 24 (d) “Health care facility“ means an ambulatory surgical 25 center or hospital licensed under

chapter 395, an alcohol or 26 chemical dependency treatment center licensed under

chapter 397, 27 an inpatient hospice licensed under

part IV of

chapter 400, a 28 nursing home licensed under

part II of

chapter 400, an 29 Florida Senate - 2022 SB 748 36-00696-22 2022748__ Page 2 of 4 CODING: Words stricken are deletions; words underlined are additions. ambulatory care center as defined in s. 408.07, an assisted 30 living facility licensed under

part I of

chapter 429, or a 31 nursing home component under

chapter 400 within a continuing 32 care facility licensed under

chapter 651. 33 (e) “Health care provider” means any individual authorized 34 by law to administer prescription drugs in this state, including 35 providers acting under another provider’s delegation and 36 supervision. 37 (f) “Insurer” means an insurer as defined in s. 624.03, a 38 self-insurance plan as defined in s. 624.031, a multiple-39 employer welfare arrangement as defined in s. 624.437, a 40 fraternal benefit society as defined in s. 632.601, a prepaid 41 limited health service organization as defined in s. 636.003, a 42 health maintenance organization as defined in s. 641.19, a 43 prepaid health clinic as defined in s. 641.402, or any health 44 care arrangement whereby risk is assumed. 45 (g) “Patient-to-provider dispensing” means the practice by 46 which a patient is dispensed a clinician-administered drug from 47 the patient’s chosen pharmacy and then transports the drug to a 48 health care provider for administration. 49 (h) “Unrelated pharmacy” means a pharmacy that is not 50 affiliated with, managed by, controlled by, or contracted 51 directly with a health care facility. 52 (i) “Unrelated pharmacy dispensing” means the practice by 53 which an unrelated pharmacy dispenses a clinician-administered 54 drug directly to a health care facility for administration to a 55 patient by a health care provider. 56

(2) An insurer may not do any of the following: 57 (

a) Reimburse a health care facility or provider for the 58 Florida Senate - 2022 SB 748 36-00696-22 2022748__ Page 3 of 4 CODING: Words stricken are deletions; words underlined are additions. administration of a clinician-administered drug obtained through 59 patient-to-provider dispensing. 60 (

b) Except as provided in paragraph (a), refuse to 61 authorize, approve, or pay a participating provider for 62 providing covered clinician-administered drugs and related 63 services to covered persons. 64 (

c) Interfere with the patient’s right to choose to obtain 65 a clinician-administered drug from the patient’s chosen health 66 care provider, health care facility, third-party drug 67 distributor or pharmacy by any means, including, but not limited 68 to, inducement, steering, or offering financial or other 69 incentives. 70 (

d) Require clinician-administered drugs to be dispensed by 71 a pharmacy selected by the insurer. 72 (

e) Limit or exclude coverage for a clinician-administered 73 drug if it was not dispensed by a pharmacy selected by the 74 insurer, if such drug would otherwise be covered. 75 (

f) Reimburse at a lesser amount clinician-administered 76 drugs dispensed by a pharmacy that was not selected by the 77 insurer. 78 (

g) Condition, deny, restrict, refuse to authorize or 79 approve, or reduce payment to a health care provider or health 80 care facility for providing covered clinician-administered drugs 81 and related services to covered persons if all criteria for 82 medical necessity are met, solely on the basis that the health 83 care provider or health care facility obtains clinician-84 administered drugs from a pharmacy that has not entered into a 85 written agreement with the patient’s insurer to provide medical 86 or pharmacy benefits. 87 Florida Senate - 2022 SB 748 36-00696-22 2022748__ Page 4 of 4 CODING: Words stricken are deletions; words underlined are additions. (

h) Impose coverage or benefits limitations; require that 88 an enrollee pay an additional fee, higher copay, higher 89 coinsurance, second copay, second coinsurance; or impose any 90 other form of price increase for clinician-administered drugs if 91 they are not dispensed by a pharmacy selected by the insurer. 92 (

i) Require an unrelated pharmacy dispensing process for 93 clinician-administered drugs. 94

Section 2. This act shall take effect July 1, 2022. 95