The Patients Choice in Specialty Pharmacy Act would bar most group health plans and health insurers from steering members to specialty pharmacies they own or control. It would also generally prevent these plans and insurers from excluding qualified specialty pharmacies that accept the same network terms and reimbursement rates as other pharmacies. Exceptions would apply for certain fraud or abuse findings, program exclusions, or an imminent risk of patient harm. The bill excludes self-insured group health plans. Its requirements would apply to plan years starting on or after January 1, 2029.
If you have coverage subject to the bill, your plan generally could not charge you more, offer you a financial incentive, or add administrative burdens to steer you to an affiliated specialty pharmacy. Qualified specialty pharmacies that meet uniform network terms and accept the same reimbursement rates could generally not be excluded. The bill does not apply to self-insured group health plans.
The bill does not specify expenses for patients, plans, or insurers.
No publicly available information.
No publicly available information.