Insurance coverage

Insurance Coverage for Clinician-Administered Medications Wanted – Unicameral Update

the Banking, Commerce and Insurance Committee heard testimony Feb. 15 about a bill that would ban health insurance coverage restrictions on clinician-administered drugs.

Senator Eliot Bostar

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The senator. Eliot Bostar

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Senator Eliot Bostar

The bill defines these drugs as outpatient prescription drugs that a patient cannot self-administer and requires the assistance of a health care provider in a clinical setting.

LB943introduced by Senator Eliot Bostar of Lincoln, would prohibit most Nebraska health insurance policies from:
• denying coverage for clinician-administered medications and related services;
• impose coverage and benefit limits or charge a higher premium or co-payment for clinician-administered drugs;
• preventing a patient from obtaining drugs administered by a clinician;
• require that drugs administered by a clinician be dispensed by a pharmacy chosen by the insurer or reimburse the insured at a lower rate; Where
• Limit or exclude coverage for a drug administered by a clinician when that drug would otherwise be covered.

Policies that cover a specific illness and self-funded employee benefit plans would be excluded from the bill’s provisions.

Bostar said insurers can currently require patients to buy prescription drugs from a contracted specialty pharmacy — a practice he called “white bagging.” The practice limits patient choice and has resulted in negative health outcomes, Bostar said.

“The white bags delayed patients getting their medications and even resulted in the wrong dose or medication being sent to hospitals,” he said.

Lori Murante of Nebraska Medical Center testified in support of LB943. Federal law requires medications to be tracked, she said, but white bags complicate that process, overloading hospitals and causing delays for patients receiving prescriptions.

“White bags allow insurers rather than healthcare providers to determine where, when and how drugs are purchased, prepared and administered,” Murante said.

Elizabeth Boals-Shively of Henderson Health Care Services also expressed support. She said the white bags caused pharmacies to send the wrong medicine or the wrong dosage of the correct medicine to her hospital.

“LB943 means patients can get their injections and infusions when and where it’s most accessible,” Boals-Shively said.

David Root of Prime Therapeutics Pharmacy Benefits Manager testified against LB943. He said the bill is anti-competitive and would force patients to pay more.

“These drugs are incredibly expensive,” Root said. “The idea that we as PBM are just going to waste this product is, frankly, insane.”

Blue Cross’ Jeremiah Blake and Nebraska’s Blue Shield were also in opposition. White bags are used sparingly and help control costs and keep premiums low, he said.

“From a patient’s perspective, these tools are a safe and effective way to get the same medication, delivered by a healthcare provider with the same therapeutic outcome, at a lower cost,” Blake said.

The committee took no immediate action on LB943.

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