loading…
loading…
(1) Any health benefit plan, except supplemental policies covering a specified disease or other limited benefit, that provides hospital, surgical, or medical expense insurance may provide coverage for health-care services under a specific treatment protocol provided by a pharmacist if:
(a) The pharmacist meets the requirements in part 6 of article 280 of title 12;
(b) The health benefit plan provides coverage for the same service provided by a licensed physician or an advanced practice registered nurse;
(c) The pharmacist is included in the health benefit plan's network of participating providers; and
(d) A reimbursement rate has been successfully negotiated in good faith between the pharmacist and the health plan.
(2) (a) A health benefit plan described in subsection (1) of this section shall provide coverage for health-care services provided by a pharmacist within a health professional shortage area, as defined in 42 U.S.C. sec. 254e, if the conditions specified in subsection (1) of this section are met.
(b) This subsection (2) does not require a carrier to contract with a pharmacy or pharmacist willing to abide by the terms and conditions for participation established by the health benefit plan or carrier.
(3) (a) Notwithstanding the provisions of subsection (1) of this section to the contrary, a health benefit plan described in subsection (1) of this section that provides treatment for substance use disorders shall reimburse a licensed pharmacist acting within the licensed pharmacist's scope of practice, and in accordance with the requirements in part 6 of article 280 of title 12, for the provision of medication-assisted treatment services if the health benefit plan provides coverage for the same services provided by a licensed physician or an advanced practice registered nurse.
(b) A health benefit plan reimbursing a licensed pharmacist pursuant to subsection (3)(a) of this section shall reimburse a licensed pharmacist at the same rate that the health benefit plan reimburses a licensed physician or an advanced practice registered nurse within the health benefit plan's network of participating providers for the same services.