MISSISSIPPI LEGISLATURE
2025 Regular Session
To: Insurance
By: Senator(s) Boyd
AN ACT TO ENACT THE PROTECTING PATIENT ACCESS TO PHYSICIAN-ADMINISTERED DRUGS ACT; TO STATE LEGISLATIVE INTENT; TO DEFINE CERTAIN TERMS; TO PROHIBIT A HEALTH INSURANCE ISSUER, PHARMACY BENEFIT MANAGER OR THE AGENT OF EITHER FROM REFUSING TO AUTHORIZE, APPROVE OR PAY A PARTICIPATING PROVIDER FOR PROVIDING COVERED PHYSICIAN-ADMINISTERED DRUGS AND RELATED SERVICES TO COVERED PERSONS; TO PROHIBIT A HEALTH INSURANCE ISSUER, PHARMACY BENEFIT MANAGER OR THE AGENT OF EITHER FROM REQUIRING A COVERED PERSON TO PAY ANY PENALTY OR ADDITIONAL FEE NOT OTHERWISE APPLICABLE TO COST-SHARING AMOUNTS PAYABLE BY THE COVERED PERSON TO OBTAIN THE PHYSICIAN-ADMINISTERED DRUG WHEN PROVIDED BY A PARTICIPATING PROVIDER; TO PROVIDE THAT ALL PROVIDER AGREEMENTS SHALL BE CONSTRUED TO INCLUDE A PROVISION THAT, WHEN ALL CRITERIA FOR MEDICAL NECESSITY ARE MET, THE DRUG AND ITS ADMINISTRATION SHALL 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; TO PROVIDE PAYMENT RATES TO PARTICIPATING PROVIDERS; TO PROVIDE THAT CONTRACT PROVISIONS IN CONFLICT WITH THIS ACT SHALL BE NULL, VOID AND UNENFORCEABLE; TO PROVIDE THAT A VIOLATION OF THIS ACT SHALL BE CONSIDERED A VIOLATION OF THE CONSUMER PROTECTION ACT, AND SHALL SUBJECT THE VIOLATOR TO ANY AND ALL ACTIONS PROVIDED FOR IN THE CONSUMER PROTECTION ACT; TO AMEND SECTION 75-24-5, MISSISSIPPI CODE OF 1972, TO CONFORM TO THE PROVISIONS OF THIS ACT; AND FOR RELATED PURPOSES.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MISSISSIPPI:
SECTION 1. This act shall be known and may be cited as the "Protecting Patient Access to Physician-Administered Drugs Act."
SECTION 2. The purpose and intent of the Protecting Patient Access to Physician-Administered Drugs Act is to ensure patient access to physician-administered drugs and related services furnished to persons covered under a health insurance contract. This act shall ensure health insurance issuers do not interfere with patients' freedom of choice with respect to providers furnishing physician-administered drugs and ensure that patients receive safe and effective drug therapies.
SECTION 3. For purposes of this act, the following words or phrases shall have the meanings ascribed herein unless the context clearly requires otherwise:
(a) "Covered person" means a policyholder, subscriber, enrollee, member or individual covered by a health insurance plan.
(b) "Health insurance issuer" has the same meaning as defined in Section 41-149-3.
(c) "Health insurance plan" has the same meaning as defined in Section 73-21-153.
(d) "Participating provider" means a physician, hospital, pharmacy, pharmacist, dentist, nurse, chiropractor, optometrist or other provider of health care services licensed or certified by the state, that has entered into an agreement with a health insurance issuer or pharmacy benefit manager to provide services, products or supplies to a patient enrolled in a health insurance plan. "Participating provider" shall include any clinic, hospital outpatient department or pharmacy under the common ownership or control of the participating provider.
(e) "Pharmacy benefit manager" has the same meaning as defined in Section 73-21-153.
(f) "Physician-administered drug" means any prescription drug, other than a vaccine, that requires administration by a provider and is not approved as a self-administered drug.
SECTION 4. (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.
(2) All provider agreements are hereby construed to include a provision that affirmatively requires that, when all criteria for medical necessity are met, the drug and its administration shall 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, Pub. L. No. 113-54, as amended.
(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 act shall be null, void and unenforceable in this state.
SECTION 5. A violation of this act shall be considered a violation of the Consumer Protection Act, Sections 75-24-1 through 75-24-29, and subjects the violator to any and all actions, including investigative demands, private actions, remedies and penalties, provided for in the Consumer Protection Act. A violation shall be deemed to occur each time a prohibited act is committed.
SECTION 6. Section 75-24-5, Mississippi Code of 1972, is amended as follows:
75-24-5. (1) Unfair methods of competition affecting commerce and unfair or deceptive trade practices in or affecting commerce are prohibited. Action may be brought under Section 75-24-5(1) only under the provisions of Section 75-24-9.
(2) Without limiting the scope of subsection (1) of this section, the following unfair methods of competition and unfair or deceptive trade practices or acts in the conduct of any trade or commerce are hereby prohibited:
(a) Passing off goods or services as those of another;
(b) Misrepresentation of the source, sponsorship, approval, or certification of goods or services;
(c) Misrepresentation of affiliation, connection, or association with, or certification by another;
(d) Misrepresentation of designations of geographic origin in connection with goods or services;
(e) Representing that goods or services have sponsorship, approval, characteristics, ingredients, uses, benefits, or quantities that they do not have or that a person has a sponsorship, approval, status, affiliation, or connection that he does not have;
(f) Representing that goods are original or new if they are reconditioned, reclaimed, used, or secondhand;
(g) Representing that goods or services are of a particular standard, quality, or grade, or that goods are of a particular style or model, if they are of another;
(h) Disparaging the goods, services, or business of another by false or misleading representation of fact;
(i) Advertising goods or services with intent not to sell them as advertised;
(j) Advertising goods or services with intent not to supply reasonably expectable public demand, unless the advertisement discloses a limitation of quantity;
(k) Misrepresentations of fact concerning the reasons for, existence of, or amounts of price reductions;
(l) Advertising by or on behalf of any licensed or regulated health care professional which does not specifically describe the license or qualifications of the licensed or regulated health care professional;
(m) Charging an increased premium for reinstating a motor vehicle insurance policy that was cancelled or suspended by the insured solely for the reason that he was transferred out of this state while serving in the United States Armed Forces or on active duty in the National Guard or United States Armed Forces Reserve. It is also an unfair practice for an insurer to charge an increased premium for a new motor vehicle insurance policy if the applicant for coverage or his covered dependents were previously insured with a different insurer and canceled that policy solely for the reason that he was transferred out of this state while serving in the United States Armed Forces or on active duty in the National Guard or United States Armed Forces Reserve. For purposes of determining premiums, an insurer shall consider such persons as having maintained continuous coverage. The provisions of this paragraph (m) shall apply only to such instances when the insured does not drive the vehicle during the period of cancellation or suspension of his policy;
(n) Violating the provisions of Section 75-24-8;
(o) Violating the provisions of Section 73-3-38;
(p) Violating any of
the provisions of Title 41, Chapter 149, Mississippi Code of 1972; * * *
(q) Violating any of
the provisions of Title 45, Chapter 38, Mississippi Code of 1972 * * *; and
(r) Violating any of the provisions of Sections 1 through 5 of this act.
SECTION 7. This act shall take effect and be in force from and after its passage.