Prohibition on requiring coverage as a pharmacy benefit. A pharmacy benefit manager or health carrier shall not require that a clinician-administered drug or the administration of a clinician-administered drug be covered as a pharmacy benefit.
A pharmacy benefit manager or health carrier: (1) may impose coverage or benefit limitations on an enrollee who obtains a clinician-administered drug from a health care provider authorized to administer the drug, or a pharmacy, only if these limitations would also be imposed were the drug to be obtained from an affiliated pharmacy or a pharmacy selected by the pharmacy benefit manager or health carrier; (2) may impose cost-sharing requirements on an enrollee who obtains a clinician-administered drug from a health care provider authorized to administer the drug, or a pharmacy, only if these requirements would also be imposed were the drug to be obtained from an affiliated pharmacy or a pharmacy selected by the pharmacy benefit manager or health carrier; and (3) shall not reimburse a health care provider or pharmacy for clinician-administered drugs and their administration, at an amount that is lower than would be applied to an affiliated pharmacy or pharmacy selected by the pharmacy benefit manager or health carrier.