(1) A health insurance issuer, pharmacy benefit manager, or the agent of either shall not:(a) Refuse to authorize, approve, or pay a participating provider for providing covered physician-administered drugs and related covered services to covered persons; or(b) Require a covered person to pay any penalty or additional fee not otherwise applicable to cost-sharing amounts payable by the covered person as designated within the benefit plan to obtain the physician-administered drug when provided by a participating provider.
(a) Refuse to authorize, approve, or pay a participating provider for providing covered physician-administered drugs and related covered services to covered persons; or
(b) Require a covered person to pay any penalty or additional fee not otherwise applicable to cost-sharing amounts payable by the covered person as designated within the benefit plan to obtain the physician-administered drug when provided by a participating provider.
(2) All provider agreements are hereby construed to include a provision that requires that when all criteria for medical necessity are met, that the drug and its administration will be payable irrespective of whether the participating provider obtains physician-administered drugs from a pharmacy that is not a participating provider in the health insurance issuer’s network. The drug supplied shall meet the supply chain security controls and chain of distribution set by the federal Drug Supply Chain Security Act.
(3) The payment to a participating provider shall be at the rate set forth in the health insurance issuer’s agreement with the participating provider applicable to such drugs, or if no such rate is included in the agreement, then at the wholesale acquisition cost.
(4) Any provision of a contract that is contrary to any provision of this chapter shall be null, void, and unenforceable in this state.