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Current as of January 01, 2025 | Updated by Findlaw Staff
(a) An insurer or its pharmacy benefits manager may not
(1) refuse to authorize, approve, or pay a provider for providing covered clinician-administered drugs and related services to a covered person if the provider has agreed to participate in the insurer's health care insurance policy according to the terms offered by the insurer or its pharmacy benefits manager;
(2) if the criteria for medical necessity are met, condition, deny, restrict, or refuse to authorize or approve a provider for a clinician-administered drug because the provider obtained the clinician-administered drug from a pharmacy that is not a network pharmacy in the insurer's or its pharmacy benefits manager's network;
(3) require a pharmacy to dispense a clinician-administered drug directly to a covered person or agent of the insured with the intention that the covered person or the agent of the insured will transport the medication to a provider for administration;
(4) require or encourage the dispensing of a clinician-administered drug to a covered person in a manner that is inconsistent with the supply chain security controls and chain of distribution set by 21 U.S.C. 360eee--360eee-4 (Drug Supply Chain Security Act);
(5) require that a clinician-administered drug be dispensed or administered to a covered person in the residence of the covered person or require use of an infusion site external to the office, department, or clinic of the provider of the covered person; nothing in this paragraph prohibits the insurer or its pharmacy benefits manager, or an agent of the insurer or its pharmacy benefits manager, from offering the use of a home infusion pharmacy or external infusion site.
(b) If a health insurance policy provides in-network and out-of-network benefits and there is not an in-network health care provider or health care facility within a 50-mile radius of the primary residence of a covered person, the health insurance policy must provide coverage to the covered person for clinician-administered drugs at the minimum in-network benefit level.
(c) In this section, “clinician-administered drug” means a drug, other than a vaccine, that requires administration by a provider and that the United States Food and Drug Administration or the drug's manufacturer has not approved for self-administration.
Cite this article: FindLaw.com - Alaska Statutes Title 21. Insurance § 21.27.951. Patient access to clinician-administered drugs - last updated January 01, 2025 | https://codes.findlaw.com/ak/title-21-insurance/ak-st-sect-21-27-951/
FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.
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