Sickest patients face insurance denials despite policy fixes: “They won’t help me” – CBS News

The state of Kentucky has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Alaska has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

Great news – Arizona has passed restrictions on copay accumulators.

The law (§20-1126) requires insurers to count any payment made by the patient or on behalf of the patient when calculating a patient’s contribution to any out-of-pocket maximum, deductible, copayment, coinsurance or any cost-sharing requirement. However, the drug must be either:

• without a generic equivalent; or
• with a generic equivalent, but the patient obtained access to the prescription drug through any of the following: (1) prior authorization, (2) a step therapy protocol, or (3) an exceptions and appeals process.

 
A “generic equivalent” means a drug that has an identical amount of the same active chemical ingredients in the same dosage form. It must meet applicable standards of strength or other nationally recognized collection. It does not include a drug that is listed by the FDA as having unresolved bioequivalence.

If a patient has obtained access to the drug through prior authorization, a step therapy protocol, or an exceptions and appeals process; the patient’s copay assistance must be counted by their insurer.

If you believe an insurance company has failed to comply with §20-1126, you can file a complaint with Arizona’s Department of Insurance.

The state of Wyoming has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Wisconsin has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Utah has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of South Dakota has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of South Carolina has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Rhode Island has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Pennsylvania has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Ohio has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of New Jersey has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of New Hampshire has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Nevada has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Nebraska has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Montana has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

“The state of Mississippi has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Mississippi has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Missouri has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Minnesota has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Michigan has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Massachusetts has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Kansas has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Hawaii has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Florida has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of California has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

The state of Alaska has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

Great news – West Virginia has passed restrictions on copay accumulators.

This law (§33-15-4t) establishes that when calculating a patient’s contribution to any applicable cost-sharing requirement, such as copayments, coinsurance, or deductibles, both insurers and pharmacy benefit managers (PBMs) must include any cost-sharing amounts paid by the insured or on their behalf by another person.

If you believe an insurance company has failed to comply with §33-15-4t, you can file a complaint with West Virginia Department of Insurance.

Great news – Washington has passed restrictions on copay accumulators.

This law (Chapter 228) requires health carriers and health care benefit managers to count any cost-sharing amounts paid by a patient or on their behalf by another person towards the enrollee’s applicable cost-sharing, deductible, or out-of-pocket maximum, regardless of the source of the payment. This applies to certain prescription drugs without a generic equivalent or preferred therapeutic equivalent, as well as drugs accessed through prior authorization, step therapy, or an exception request process. This bill provides exceptions for high-deductible healthplans to preserve the patient’s ability to make tax-exempt contributions and withdrawals from a health savings account.

If you believe an insurance company has failed to comply with Chapter 228, you can file a complaint with Washington Department of Insurance.

Great news – Virginia has passed restrictions on copay accumulators.

This law (§38.2-3407.20) states that when calculating a patient’s overall contribution to any out-of-pocket maximum or any cost-sharing requirement under a health paln, a carrier shall include any amounts paid by the patient or paid on beahlf of the patient by another person. However, if the application of this provision would result in a health plan’s ineligibility to qualify as a Health Savings Account-qualified High Deductible Health Plan, then the above requirement shall not apply until after the patient has satisified the minimum deductible.

If you believe an insurance company has failed to comply with §38.2-3407.20, you can file a complaint with Virginia Department of Insurance.

Great news – Vermont has passed restrictions on copay accumulators.

This law (8 V.S.A. chapter 107 § 4093) requires health benefit plan issuers or pharmacy benefit managers (PBMs) to apply any payment made by or on behalf of a patient for certain prescription drugs to the patient’s deductible, copayment, cost-sharing responsibility, or out-of-pocket maximum. However, this only applies to prescription drugs that do not have a generic equivalent or interchangeable biological product, or where the patient has obtained access to the drug through a prior authorization process, step therapy protocol, or the issuer’s exceptions and appeals process. These provisions apply to a high-deductible health plan only to the extent that it would not disqualify the plan from eligibility for a health savings account pursuant to 26 U.S.C. § 223.

Insurers also cannot require patients to pay more at the point of sale for a covered prescription drug than the least of the applicable cost-sharing amount, the maximum allowable cost for the drug, or the amount the covered person would pay for the drug (after application of any known discounts) if the covered person were paying the cash price.

If you believe an insurance company has failed to comply with 8 V.S.A. chapter 107 § 4093, you can file a complaint with Vermont’s Department of Insurance.

Great news – Texas has passed restrictions on copay accumulators.

This law (§ 1369.0542) amends the Texas Insurance Code to require health benefit plan issuers or pharmacy benefit managers (PBMs) to apply any third-party payment, financial assistance, discount, product voucher, or other reduction in out-of-pocket expenses made by or on behalf of a patient for certain prescription drugs to the patient’s deductible, copayment, cost-sharing responsibility, or out-of-pocket maximum. However, this only applies to prescription drugs that do not have a generic equivalent or interchangeable biological product, or where the patient has obtained access to the drug through a prior authorization process, step therapy protocol, or the issuer’s exceptions and appeals process.

If you believe an insurance company has failed to comply with § 1369.0542, you can file a complaint with Texas Department of Insurance.

Great news – Tennessee has passed restrictions on copay accumulators.

This law (Tennessee Code Annotated, Section 56-7-3201) amends Tennessee’s insurance laws to require insurers to include cost sharing amounts paid by the enrollee, or on behalf of the enrollee by another person, when calculating an enrollee’s contribution to an applicable cost sharing requirement.

If you believe an insurance company has failed to comply with Tennessee Code Annotated, Section 56-7-3201, you can file a complaint with the Tennessee Department of Insurance.

Great news – Oregon has passed restrictions on copay accumulators.

This law (HB 4113) requires insurers to include all amounts paid by an enrollee or paid by another person on behalf of an enrollee when calculating the enrollee’s contribution to an out-of-pocket maximum, deductible, copayment, coinsurance or other cost-sharing requirement applied to the drug if:

1) The drug does not have a generic equivalent; or
2) The drug has a generic equivalent and the enrollee has: (a) obtained prior authorization from the insurer or pharmacy benefit manager; (b) complied with a step therapy protocol; or (c) received approval from the insurer or pharmacy benefit manager through the insurer’s or the pharmacy benefit manager’s exceptions, appeal or review process.

If you believe an insurance company has failed to comply with HB 4113, you can file a complaint with Oregon’s Department of Insurance.

Great news – Oklahoma has passed restrictions on copay accumulators.

This law (36 O.S. Supp. 2020, Section 1250.5[18]) prohibits insurers and pharmacy benefit managers from failing to include any amount paid by a patient or on their behalf when calculating the patient’s total contribution to out-of-pocket maximums, deductibles, copayments, coinsurance, or other cost-sharing requirements.

If you believe an insurance company has failed to comply with 36 O.S. Supp. 2020, Section 1250.5(18), you can file a complaint with Oklahoma’s Department of Insurance.

Great news – North Dakota has passed restrictions on copay accumulators.

Starting January 1, 2026, this law (North Dakota Century Code 26.1-36) prohibits health plans from not including any amount paid by the enrollee or paid on behalf of the enrollee by another person when calculating an enrollee’s overall contribution to any out-of-pocket maximum or any cost-sharing requirement for a prescription drug under the health plan. The health benefit plan also may not vary the out-of-pocket maximum or cost-sharing requirement, or otherwise design benefits accounting for the availability of a cost-sharing assistance program for a prescription drug.

However, if the application of this provision would result in a health plan’s ineligibility to qualify as a Health Savings Account-qualified High Deductible Health Plan, then the above requirement shall not apply until after the patient has satisified the minimum deductible.

If you believe an insurance company has failed to comply with North Dakota Century Code 26.1-36, you can file a complaint with North Dakota’s Department of Insurance.

Great news – North Carolina has passed restrictions on copay accumulators.

This law (§ 58-56A-3) requires insurers and pharmacy benefit managers (PBMs) to include any amounts paid by the insured, or on the insured’s behalf, for a prescription that is either without an AB-rated generic equivalent or with an AB-rated generic equivalent if the insured has obtained authorization for the drug through prior authorization from the insurer or PBM, a step therapy protocol, or the exception or appeal process of the insurer or PMB.

If you believe an insurance company has failed to comply with § 58-56A-3, you can file a complaint with North Carolina’s Department of Insurance.

Great news – New York has passed restrictions on copay accumulators.

This law (A01741) requires any third-party payments, financial assistance, discounts, vouchers, or other price reduction instruments for out-of-pocket expenses made on behalf of a patient for the cost of prescription drugs to be applied to the patient’s deductible, copayment, coinsurance, out-of-pocket maximum, or any other cost-sharing requirement when calculating the insured’s overall contribution to any out-of-pocket maximum or cost-sharing requirement.

This law applies to individual and group health insurance plans, as well as contracts issued by medical expense indemnity, hospital service, and health service corporations that provide prescription drug coverage.

The act does have an exception for high-deductible health eligible for health savings accounts, where the requirement would apply after the patient has satisified the minimum deductible, except for preventative care services.

If you believe an insurance company has failed to comply with A01741, you can file a complaint with New York’s Department of Insurance.

Great news – New Mexico has passed restrictions on copay accumulators.

The law (SB 51) requires insurers to credit patients for the full value of any discounts or payments made by third parties when calculating the patient’s cost-sharing obligation for covered prescription drugs. The act prevents insurers from charging different cost-sharing amounts for prescription drugs or pharmacy services obtained at non-affiliated pharmacies or for administration of prescription drugs at different infusion sites, though they can communicate with patients about lower-cost options.

Insurers cannot require patients to pay more at the point of sale for a covered prescription drug than the least of the applicable cost-sharing amount, the amount the patient would pay without insurance, the total pharmacy reimbursement amount, or the value of the manufacturer’s rebate.

This law applies to state-regulated commercial plans and state public employee plans.

If you believe an insurance company has failed to comply with SB 51, you can file a complaint with New Mexcio’s Department of Insurance.

The state of Maryland has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

This law (15–118.1) requires insurers to include cost-sharing amounts paid by the patient or on the patient’s behalf (including discounts, financial assistance payments, product vouchers, or other out-of-pocket expenses) when calculating the patient’s contribution to an applicable cost-sharing requirement, such as a copay, coinsurance, deductible, or out-of-pocket max.

This applies for drugs that are covered under the patient’s health plan and either

• do not have a generic equivalent, biosimilar, or interchangeable biological product; or
• have a generic equivalent, biosimilar, or interchangeable biological product, but the patient is using the prescription and has obtained prior authorization, complied with a step therapy protocol, or received approval through an exceptions and appeals process.

However, if the application of this provision would result in a health plan’s ineligibility to qualify as a Health Savings Account-qualified High Deductible Health Plan, then the above requirement shall not apply until after the patient has satisified the minimum deductible.

The health benefit plan also may not vary the out-of-pocket maximum or cost-sharing requirement, or otherwise design benefits accounting for the availability of a cost-sharing assistance program for a prescription drug.

If you believe an insurance company has failed to comply with 15–118.1, you can file a complaint with Maryland’s Department of Insurance.

Great news – Maine has passed restrictions on copay accumulators.

This law (24-A MRSA §4349, sub-§6) requires health insurance carriers and their pharmacy benefit managers to include cost-sharing amounts paid on behalf of a patient when calculating the patient’s contribution to any out-of-pocket maximum, deductible, or copayment when a drug does not have an alternative generic equivalent or was obtained through prior authorization, a step therapy override exception, or an exception or appeal process. The act’s requirements apply to prescription drug benefits provided pursuant to an insurance policy by a carrier or a PBM.

The bill also requires any third party that provides cost-sharing amounts paid on behalf of a patient to notify the covered person prior to or within 7 days of the acceptance of the financial assistance of the total amount of assistance available and the duration for which it is available, and cannot condition the assistance on enrollment in a specific health plan or type of health plan, except as permitted under federal law.

If you believe an insurance company has failed to comply with 24-A MRSA §4349, sub-§6, you can file a complaint with Maine’s Department of Insurance.

Great news – Louisiana has passed restrictions on copay accumulators.

This law (§22:976.1) requires health insurance issuers to include any cost-sharing amounts paid by the patient or on their behalf when calculating the enrollee’s contribution to any applicable cost-sharing requirement.

If you believe an insurance company has failed to comply with §22:976.1, you can file a complaint with Louisiana’s Department of Insurance.

Great news – Kentucky has passed restrictions on copay accumulators.

This law (§304.17A-164) prevents insurers from requiring a patient purchasing a prescription drug to pay a cost-sharing amount greater than the amount the insured would pay for the drug if the patient were to purchase without coverage. The law also prohibits the insurer from excluding any cost-sharing amounts paid by a patient or on behalf of a patient by another person for a prescription drug, when calculating an insured’s contribution to any applicable cost-sharing requirement.

The law does not apply in the case of a prescription drug that has a generic alternative, unless the insured has obtained access to the prescription drug through prior authorization, a step therapy protocol, or the insurer’s exceptions and appeals process. It also exempts fully insured or self-insured health benefit plans provided to state employees from the requirement that they count any cost-sharing amount paid by or on behalf of a patient.

If you believe an insurance company has failed to comply with §304.17A-164, you can file a complaint with Kentucky’s Department of Insurance.

Great news – Iowa has passed restrictions on copay accumulators.

Starting January 1, 2026, this law (Section 510B.8, Code 2025, Subsections 5 and 7) prohibits health plans from not including any amount paid by the enrollee or paid on behalf of the enrollee by another person when calculating an enrollee’s overall contribution to any out-of-pocket maximum or any cost-sharing requirement for a prescription drug under the health plan.

However, if the application of this provision would result in a health plan’s ineligibility to qualify as a Health Savings Account-qualified High Deductible Health Plan, then the above requirement shall not apply until after the patient has satisified the minimum deductible.

If you believe an insurance company has failed to comply with Section 510B.8, Code 2025, Subsections 5 and 7, you can file a complaint with Iowa’s Department of Insurance.

Great news – Indiana has passed restrictions on copay accumulators.

Starting January 1, 2026, this law (IC 27-1-24.5-27.7) requires health plans fto include any amount paid by the enrollee or paid on behalf of the enrollee by another person when calculating an enrollee’s overall contribution to any cost-sharing requirement for a prescription drug under the health plan. The health benefit plan also may not vary the out-of-pocket maximum or cost-sharing requirement, or otherwise design benefits accounting for the availability of a cost-sharing assistance program for a prescription drug.

However, if the application of this provision would result in a health plan’s ineligibility to qualify as a Health Savings Account-qualified High Deductible Health Plan, then the above requirement shall not apply until after the patient has satisified the minimum deductible.

If you believe an insurance company has failed to comply with IC 27-1-24.5-27.7, you can file a complaint with Indiana’s Department of Insurance.

Great news – Illinois has passed restrictions on copay accumulators.

This law (215 ILCS 134/30(d)) requires a health care plan to apply any third-party payments, financial assistance, discount, product vouchers, or any other reducation in out-of-pocket expenses made by or on behalf of a patient toward the patient’s deductible, copay, or cost-sharing responsibility, or out-of-pocket maximum.

If you believe an insurance company has failed to comply with 215 ILCS 134/30(d), you can file a complaint with Illinois’s Department of Insurance.

Great news – Georgia has passed restrictions on copay accumulators.

This law (§33-64-10) requires a pharmacy benefits manager to apply any third-party payment, financial assistance, discount, product voucher, or other reduction in out-of-pocket expenses made by or on behalf of an insured toward an insured’s cost share or copay responsibility.

If you believe an insurance company has failed to comply with O.C.G.A. §33-64-10, you can file a complaint with Georgia’s Department of Insurance.

Great news – Delaware has passed restrictions on copay accumulators.

This law (Title 18, § 3350B, § 3566A, § 3381A, and § 3382A) requires insurers to include any cost-sharing amounts paid by the patient or on behalf of the patient by another person, when calculating the patient’s contribution to any applicable cost-sharing requirement.

If doing so would result in Health Savings Account ineligibility under the federal Internal Revenue Code, then the requirement applies for HSA-qualified High Deductible Health Plans after the patient has satisfied the IRS minimum deductible — unless the services fall under preventative care per the Internal Revenue Code § 223(c)(2)(C).

If you believe an insurance company has failed to comply with Title 18, you can file a complaint with Delaware’s Department of Insurance.

Great news – Connecticut has passed restrictions on copay accumulators.

These law (Public Act No. 21-14 and HB 7192) require insurers to give credit for any discount provided or payment made by a third party for the amount of, or any portion of a patient’s coinsurance, copayment, deductible or other out-of-pocket expense. In addition, insurers must count a member’s out-of-pocket payments for prescription drugs toward in-network deductibles, copays, and coinsurance when the member pays a licensed pharmacy or provider directly without a claim, or buys the drug out of network, as long as the price paid is lower than the insurer’s average in-network cost and proof of payment is provided if required.

If you believe an insurance company has failed to comply with Public Act No. 21-14 or HB 7192, you can file a complaint with Connecticut’s Department of Insurance.

Great news – Colorado has passed restrictions on copay accumulators.

The law (§10-16-161) requires insurers to include any amount paid by the paitent or by another person on their behalf when calculating the patient’s overall contribution to their out-of-pocket maximum or cost-sharing requrement under the patient’s plan if:

– the prescription drug does not have a generic equivalent, biosimilar, or interchangeable biological product; or
– the prescription drug has a generic equivalent, biosimilar, or interchangeable biological product, but the patient is using the prescription and has (1) obtained prior authorization, (2) complied with a step therapy protocol, or (3) received approval through an exceptions and appeals process.

If a patient has obtained access to the drug through prior authorization, a step therapy protocol, or an exceptions and appeals process; the patient’s copay assistance must be counted by their insurer.

If you believe an insurance company has failed to comply with §10-16-161 you can file a complaint with Colorado’s Department of Insurance.

Great news – Arkansas has passed restrictions on copay accumulators.

The law (Arkansas Code Title 23, Chapter 79, Subchapter 21) requires insurers to count any cost-sharing amounts paid by the patient or on behalf of the patient when calculating a patient’s cost-sharing contribution. The cost-sharing requirement does not apply if a name-brand prescription drug is prescribed and it:

– is not considered to be medically necessary by the prescriber; or
– has a medically appropriate generic equivalent.

This law applies to state-regulated commercial plans, Arkansas public employee plans, and Arkansas’s Medicaid expansion program, Arkansas Health and Opportunities for Me (ARHOME).

If you believe an insurance company has failed to comply with Arkansas Code Title 23, Chapter 79, Subchapter 21, you can file a complaint with Arkansas’s Department of Insurance.

The state of Alabama has yet to pass restrictions on copay accumulators or maximizers. Contact your state legislators and ask for their support.

Washington has some non-medical switching protections for prescription drugs related to mental health.

This law (RCW 48.43.0961) states that a health carrier or health care benefit manager may not require the substitution of a nonpreferred drug with a preferred drug in a given therapeutic class, or increase a patient’s cost-sharing obligation mid-plan year for the drug, if the prescription is for a refill of an antipsychotic, antidepressant, antiepileptic, or other drug prescribed to the patient to treat a serious mental illness, the patient is medically stable on the drug, and a participating provider continues to prescribe the drug.

The carrier of the plan can still require generic substitution during the current plan year, the carrier of the plan can still add new drugs to its formulary during the current plan year, and the carrier can still remove a drug from its formulary for reasons of patient safety or efficacy concerns. A participating provider can still prescribe a different drug that is covered by the plan and medically approriate for the patient.

If you believe an insurance company has failed to comply with RCW 48.43.0961, you can file a complaint with Washington Department of Insurance.

Great news – Texas has some non-medical switching protections.

This law (Title 8, Sec. 1369.0541 & Sec. 1369.055) requires that, at least 60 days prior to modifying a formulary, a health benefit plan must provide written notice of the modification to each affected enrollee in an affected group health benefit plan, and each affected individual health benefit plan holder. A health benefit plan issuer also may not modify drug coverage provided under a health benefit plan unless the modification occurs at the time of coverage renewal, and is uniform across the plan. In addition, a health benefit plan issuer must offer an enrollee coverage of a drug at the contracted benefit level, regardless of whether the drug has been removed from the plan’s formulary before the plan renewal date, if the enrollee was previously approved or covered for the drug under the plan. This regulation applies until the date of plan renewal.

If you believe an insurance company has failed to comply with Section 1369.054-1, you can file a complaint with Texas Department of Insurance.

Great news – Rhode Island has non-medical switching protections.

This law (S2294A) requires insurers to give 30 days notice before making changes in preferred or tiered cost sharing status of covered drugs. Any drug that is deemed unsafe may be removed immediately without prior notice.

If you believe an insurance company has failed to comply with S2294A, you can file a complaint with Rhode Island’s Department of Insurance.

Great news – New York has non-medical switching protections.

This law (ISC Chapter 28, Article 32, Section 3242) health care plans must provide notice to policyholders 30 days prior to open enrollment of intent to make any of the formulary changes below for a prescription drug during the ensuing plan year. Health care plans cannot 1) remove a prescription drug from formulary during the plan year, 2) move a prescription drug to a tier with a larger deductible, copayment, or coinsurance during the plan year, or 3) add new utilization management requirements during the plan year. However, if an AB-rated generic equivalent or interchangable biosimilar is added to the formulary, the prohibition on moving tiers does not apply.

Great news – New Mexico has non-medical switching protections.

This law (NM Stat § 13-7-15) prevents health plans from making any of the following changes to coverage for a prescription drug within 120 days of any previous change to coverage for that prescription drug, unless a generic version of the drug is available.

The changes include: (1) reclassifying a drug to a higher tier of the formulary, (2) reclassifying a drug from a preferred classification to a non-preferred classification, unless it is moving the drug to a lower tier on the formulary, (3) increasing the cost-sharing, copayment, deductible or co-insurance charges for a drug, (4) removing a drug from the formulary, (5) establishing a prior authorization requirement, (6) imposing or modifying a drug’s quantity limit, or (7) imposing a step therapy restriction.

If you believe an insurance company has failed to comply with NM Stat § 13-7-15, you can file a complaint with New Mexico’s Department of Insurance.

Nevada has non-medical switching protections.

This law (NAC 689A.425 and NRS 689A.04045) prohibits health plans from making certain formulary changes during the course of a plan year, including 1) removing a prescription drug from the formulary and 2) moving a drug to a tier with a larger deductible, copayment, or coinsurance (a health plan subject to 689A.425 may still remove a drug from their formulary during a plan year under certain circumstances such as when the plan adds a generic approved by the FDA for use as an alternative to the brand name drug to their formulary). In addition, issuers of individual policies may not limit or reduce coverage for a prescription drug that has been previously approved for coverage for an insured during term of their policy if 1) the insured’s health care provider reasonably determines that none of the alternative drugs approved for coverage are medically appropriate and 2) the drug is appropriately prescribed and considered safe for treating the insured’s medical condition.

If you believe an insurance company has failed to comply with NAC 689A.425 and NRS 689A.04045, you can file a complaint with Nevada’s Department of Insurance.

Montana has passed protections from non-medical switching.

This law (SB 449) mandates that when enrollees switch health plans, prior authorizations granted by their previous insurer must be honored for at least the first 90 days of the new coverage, with certain exceptions and subject to the terms of the new plan.

If you believe an insurance company has failed to comply with SB 449, you can file a complaint with Montana Department of Insurance.

“Maryland has non-medical switching protections.

This law (Chapter 503) requires any entity that removes a drug from its formulary or moves it to a benefit tier that requires a patient to pay a higher deductible, copayment, or coinsurance amount provides a patient with (1) notice of the change at least 30 days before the change is made, and (2) notice of the process for requesting an exemption.

If you believe an insurance company has failed to comply with Chapter 503, you can file a complaint with Maryland’s Department of Insurance.

Maine has non-medical switching protections.

This law (24-A MRSA §4311, sub-§1) requires that a health plan provides an enrolled patient with at least 60 days’ written notice of an adverse change to a formulary, meaning a change that removes a drug currently prescribed from the formulary or moving the drug to a different tier with a higher cost-sharing requirement.

If a drug is removed from a formulary, the health plan must notify the patient of their ability to request an exception and provide a form for the patient to use to request an exception. If a patient has already received prior authorization for that drug, the health plan shall continue to honor the existing authorization until it expires. However, the aformementioned do not apply when a drug has been removed because of safety concerns.

If you believe an insurance company has failed to comply with 24-A MRSA §4311, sub-§1, you can file a complaint with Maine’s Department of Insurance.

Louisiana has non-medical switching protections.

This law (§ 1060.1) requires insurers to provide in plain language (1) notice that the plan uses one or more drug formularies, (2) an explanation of what a drug formulary is, (3) a statement regarding the method the health insurer uses to determine the drugs to be included in or excluded from a drug formulary, (4) a statement of how often the health insurer reviews the contents of each drug formulary, and (5) notice that a patient may contact the insurer to determine whether a drug is included in a particular formulary.

An insurer must offer any enrolled patient any drug that was approved or covered at the contracted benefit level and until the patient’s plan renewal date, regardless of whether the drug has been removed from the plan’s formulary before the plan renewal date.

If you believe an insurance company has failed to comply with § 1060.1, you can file a complaint with Louisiana’s Department of Insurance.

Iowa has non-medical switching protections.

This law (§ 514F.9) prevents health carriers, health benefit plans, or utilization review organizations from limiting or excluding coverage of a prescription drug for any covered patient who is medically stable on a drug as determined by a health care professional, if all of the following apply (1) the prescription drug was previously approved by the health carrier; (2) the prescriber has prescribed the drug within the last six months, (3) the patient continues to be an enrollee of the plan.

If you believe an insurance company has failed to comply with § 514F.9 you can file a complaint with Iowa’s Department of Insurance.

Indiana has passed protections from non-medical switching.

This law (Public Law 19) prevents state employee health plans from removing a prescription drug from its formulary, changing the cost sharing requirements for a prescription drug, or changing the utilization review requirements for a prescription drug unless the plan does at least one of the following: (1) send written notice of the removal or change to the patient at least 60 days before effective date; (2) send written notice of the removal or change and a 60 day supply of the prescription drug if the patient has been prescribed the drug during the preceding 12 month period and has requested a refill.

This law applies to both state-regulated health commercial plans and state public employee plans.

If you believe an insurance company has failed to comply with Public Law 19, you can file a complaint with Indiana’s Department of Insurance.

Illinois has passed protections from non-medical switching.

This law (215 ILCS 134/25) states that a health care plan cannot remove a drug from its formulary or alter its preferred or cost-tier sharing unless 60 days notice is given before the change, including (1) general notification to current and prospective enrollees; 2) direct notification to enrollees currently using the drug, explaining how to request coverage determinations and exceptions including the option for enrollees to continue coverage if a prescribing provider certifies medical necessity; and 3) direct notification to prescribing providers about affected enrollees, with a form to certify medical necessity. If the prescribing provider certifies a drug’s medical necessity, the health plan must continue coverage without increasing costs, restricting the drug to a higher tier, or denying the drug for ongoing coverage.

If you believe an insurance company has failed to comply with 215 ILCS 134/25, you can file a complaint with Illinois’s Department of Insurance.

Florida has passed protections from non-medical switching.

This law (Chapter No. 2023-29) requires pharmacy benefit managers to, upon revising their formularies of covered prescription drugs during a plan year, provide a 60-day continuity-of-care period, and the covered prescription drug must be provided at the same cost for the patient for a period of 60 days. The 60-day continuity-of-care period starts when the patient is notified.

“Connecticut has passed protections from non-medical switching.

This law (Public Act No. 21-96) prohibits health carriers from (1) removing a prescription drug from the drug formulary or list of covered drugs during a plan year; or (2) moving a prescription drug from a lower cost-sharing tier to a higher cost-sharing tier during a plan year unless the drug is subject to an in-network coinsurance, copayment or deductible that is $40 or less per prescription per month in any tier. It does allow for formulary changes if a generic or biosimilar drug is added at a lower cost.

If you believe an insurance company has failed to comply with Public Act No. 21-96, you can file a complaint with Connecticut’s Department of Insurance.

“Colorado has passed protections from non-medical switching.

This law (§10-16-122.4) requires insurers who use pharmacy benefit managers (PBMs) cannot change their drug formulary (list of drugs the plan covers) in the middle of a current plan year. It does allow for formulary changes if a generic or biosimilar drug is added at a lower cost, or if a drug’s cost increases significantly, provided advance notice is given.

If you believe an insurance company has failed to comply with §10-16-122.4 you can file a complaint with Colorado’s Department of Insurance.

“California has passed protections from non-medical switching.

This law (California Health and Safety Code, Section 1367.22) prohibits health care service plans (aka HMOs) from limiting or excluding coverage for a drug for an enrollee that has previously had the drug approved for coverage by the plan (Note: This section does not prohibit generic substitutions as authorized under Section 4073 of the Business and Professions Code).

If you believe an insurance company has failed to comply with Section 1367.22 you can file a complaint with California’s Department of Insurance.

Arizona has passed protections from non-medical switching.

Starting in 2026, this law (ARS Title 20, Chapter 25, Article 2, Sections 20-3335 and 20-3336) prevents insurers from limiting or excluding prescription drug coverage for individuals who are already on specific medications within the same health care plan year. If a formulary change occurs, the insurer must notify affected individuals and their prescribing health care providers at least 60 days in advance, detailing the process for maintaining coverage of non-formulary drugs.

If you believe an insurance company has failed to comply with ARS Title 20, Chapter 25, Article 2, Sections 20-3335 and 20-3336, you can file a complaint with Arizona’s Department of Insurance.

The state of Wyoming has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Wisconsin has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of West Virginia has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Virginia has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Vermont has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Utah has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Tennessee has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of South Dakota has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of South Carolina has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Pennsylvania has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Oregon has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Oklahoma has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Ohio has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of North Dakota has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of North Carolina has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of New Jersey has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of New Hampshire has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Nebraska has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Missouri has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Minnesota has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Michigan has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Massachusetts has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Kentucky has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Kansas has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

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The state of Hawaii has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Georgia has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Delaware has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Arkansas has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Alabama has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Washington has enacted government price-setting legislation. This law (SB 5532) creates a Prescription Drug Affordability Board (PDAB) that has the authority to review prescription drug costs through affordability reviews and then implement recommendations, including setting an upper payment limit (UPL) for certain prescription drugs. The Washington PDAB has authority to set UPLs for both public health plans and state-regulated commercial plans.

The state of Vermont has enacted government price-setting legislation. These laws (S 126 and S 98) empowers the Green Mountain Care Board (GMCB) to implement reference-based pricing based on percentage of Medicare for services delivered outside a hospital by setting the minimum amounts that shall be paid for items provided and services delivered by nonhospital-based health care professionals, starting in 2027. GMCB is also tasked with developing a plan to regulate drug costs, taking into consideration of state PDAB activities and the Medicare Drug Price Negotiation Program.

The state of Oregon has enacted government price-setting legislation. This law (ORS 646A.693-697) creates a Prescription Drug Affordability Board (PDAB) that has the authority to review prescription drug costs through affordability reviews and then implement recommendations. The Oregon PDAB does not have the authority to set UPLs, but has jurisdiction over both public health plans and state-regulated commercial plans.

The state of New Jersey has enacted government price-setting legislation. This law (P.L. 2023, c. 106) creates a Drug Affordability Council that has the authority to review prescription drug costs through affordability reviews and then implement recommendations. The New Jersey PDAB does not have the authority to set UPLs, but has jurisdiction over both public health plans and state-regulated commercial plans.

The state of Minnesota has enacted government price-setting legislation. This law (62J.87; Minnesota 2023 Laws, Chapter 57, Article 2, Section 30) creates a Prescription Drug Affordability Board (PDAB) that has the authority to review prescription drug costs through affordability reviews and then implement recommendations, including setting an upper payment limit (UPL) for certain prescription drugs. The Minnesota PDAB has authority to set UPLs for both public health plans and state-regulated commercial plans.

The state of Maryland has enacted government price-setting legislation. These laws (MD Health – General Code § 21-2C and SB 357/HB 424 HB 23-1225) create a Prescription Drug Affordability Board (PDAB) that has the authority to review prescription drug costs through affordability reviews and then implement recommendations, including setting an upper payment limit (UPL) for certain prescription drugs. The Maryland PDAB has authority to set UPLs for both public health plans and state-regulated commercial plans.

The state of Maine has enacted government price-setting legislation. This law (MRS Title 5 Chapter 167-1) create a Prescription Drug Affordability Board (PDAB) within the ME Office of Affordable Health Care that has the authority to review prescription drug costs through affordability reviews and then implement recommendations. The Maine PDAB is limited to implementing government price-setting policies in public health plans, does not have the authority to set UPLs.

The state of Colorado has enacted government price-setting legislation. These laws (SB 21-175 and HB 23-1225) create a Prescription Drug Affordability Board (PDAB) within the CO Division of Insurance that has the authority to review prescription drug costs through affordability reviews and then implement recommendations, including setting an upper payment limit (UPL) for certain prescription drugs. The Colorado PDAB has authority to set UPLs for both public health plans and state-regulated commercial plans.

The state of Wyoming has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Wisconsin has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of West Virginia has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Virginia has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Utah has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Texas has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Tennessee has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of South Dakota has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of South Carolina has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Rhode Island has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Pennsylvania has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Oklahoma has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Ohio has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of North Dakota has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of North Carolina has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of New York has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of New Mexico has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of New Hampshire has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Nevada has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Nebraska has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Montana has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Missouri has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Mississippi has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Michigan has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Massachusetts has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Louisiana has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Kansas has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Iowa has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Indiana has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Illinois has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Georgia has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Florida has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Delaware has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Connecticut has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of California has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Arkansas has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Arizona has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Alaska has yet to pass restrictions on non-medical switching. Contact your state legislators and ask for their support.

The state of Alabama has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Oregon has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

Great news – Mississippi has enacted a law restricting white bagging.

The law (HB 17) states that PBMs are prohibited from:

(a) Refusing to authorize, approve, or pay a provider for providing covered physician-administered drugs and related covered services to patients; or
(b) Requiring a patient to pay any penalty or additional fee (in addition to the cost-sharing amounts required by the patient as outlined within their health plan) to obtain the physician-administered drug when provided by a participating provider.

If you believe an insurance company has failed to comply with HB 17, you can file a complaint with Mississippi’s Department of Insurance.

Great news – Arkansas has enacted a law restricting or prohibiting white bagging.

The Arkansas (AR Code § 23-99-1503) law only applies to hematology and oncology patients. However, the Arkansas insurance commissioner has the power to expand the law to cover more conditions. This law states that a provider may make the determination whether it is in the best interest of the patient to bill their healthcare payer (under the patient’s medical benefit) or pharmacy benefits carrier (under the patient’s pharmacy benefit) for drugs ordinarily covered by the payer. The payer must reimburse for the cost and administration of the drug through the medical or pharmacy benefit, as determined by the provider.

If you believe an insurance company has failed to comply with AR Code § 23-99-1503, you can file a complaint with Arkansas’s Department of Insurance.

Great news – Louisiana has enacted a law restricting or prohibiting white bagging.

The law (La. Stat. Ann. § 22:1020.53) states that if medical necessity criteria are met, an insurer or PBM may not condition, deny, restrict, or refuse to authorize or refuse to approve a provider for a medically necessary, clinician-administered drug because the provider obtained the drug from a pharmacy that is not an insurer’s network pharmacy or a PBM’s network pharmacy. PBMs are also prohibited from requiring a covered person to pay an additional fee, or any other increased cost-sharing amount (in addition to the cost-sharing designated within their health plan) to obtain the physician-administered drug when provided by a participating provider.

If you believe an insurance company has failed to comply with La. Stat. Ann. § 22:1020.53, you can file a complaint with Louisiana’s Department of Insurance.

Great news – Minnesota has enacted a law restricting white bagging.

The Minnesota law states that PBMs or health carriers requiring clinician-administered drugs to be obtained from a specialty pharmacy establish and disclose a process for the healthcare provider to appeal and make exceptions if:

1. The drug is not delivered on the date/time and at the location as requested by the provider OR
2. The healthcare provider believes an enrollee may experience immediate and irreparable harm without immediate one-time use of the drug the provider has in stock.

If you believe an insurance company has failed to comply with Chapter 62W.15 (2024 Minnesota Statutes), you can file a complaint with Minnesota’s Department of Insurance.

Great news – Nebraska has enacted a law restricting white bagging.

The law (LB 198) states that PBMs or health carriers requiring clinician-administered drugs to be obtained from a specialty pharmacy establish and disclose a process for the healthcare provider to appeal and make exceptions if:

1. The drug is not delivered on the date/time and at the location as requested by the provider OR
2. The healthcare provider believes an enrollee may experience immediate and irreparable harm without immediate administration of the drug the provider has in stock.

In addition:

• PBMs may not deny authorization or reimbursement to a provider for dispensing a clinician-administered drug solely based on cost when the plan’s cost is substantially similar to using the PBM-selected specialty pharmacy
• PBMs may not refuse to authorize or reimburse a participating provider for administering covered clinician-administered drugs under the provider’s network agreement
• PBMs may not penalize or remove a provider from the network just because the provider refuses to administer a drug supplied by a PBM-selected specialty pharmacy
• PBMs may not force a covered person to use a specialty pharmacy if the participating provider chosen by the covered person can source and administer the drug at substantially similar cost

If you believe an insurance company has failed to comply with LB 198, you can file a complaint with Nebraska’s Department of Insurance.

Great news – North Dakota has enacted a law prohibiting white bagging.

This law (19-02.1-16.6) prohibits PBMs and third-party payers from requiring by contract, policy, or procedure that a pharmacy designated by the PBM dispense a medication directly to a health care setting for a participating provider to administer to a patient. PBMs and third-party payers also many not condition, deny, restrict, refuse to authorize, or reduce payment to a provider for clinician-administered drugs not obtained through a mail-order pharmacy or PBM affiliate.

If you believe an insurance company has failed to comply with 19-02.1-16.6, you can file a complaint with North Dakota’s Department of Insurance.

Great news – Ohio has enacted a law prohibiting white bagging.

This law (Ohio Rev. Code § 5167.24(4)) states that the state PBM contracted with Ohio Medicaid is prohibited from requiring a Medicaid recipient to obtain a specialty drug from a specialty pharmacy owned or otherwise associated with the state PBM.

If you believe an insurance company has failed to comply with Ohio Rev. Code § 5167.24(4), you can file a complaint with Ohio’s Department of Insurance.

Great news – Oklahoma has enacted a law ensuring reimbursement for provider-administered drugs. However, Oklahoma does not prohibit PBMs from engaging in white bagging.

This law (HB 1713) states that a) PBMs are prohibited from refusing to authorize, approve, or pay a participating provider for providing covered provider-administered drugs to patients; and b) providers are allowed to dispense and administer a covered provider-administered drug based on a patient’s best interest, provided that the provider that administers the drug agrees to the terms and conditions of network participation and accept, as payment in full, reimbursement for the drug at the PBM’s negotiated contracted rate.

If you believe an insurance company has failed to comply with HB 1713, you can file a complaint with Oklahoma’s Department of Insurance.

Great news – Rhode Island has enacted a law restricting or prohibiting white bagging.

The Rhode Island law states that a health insurer or third party cannot review to authorize, approve, or pay a provider for clinician-administered drug that was administered and dispensed by any in-network hospital or clinic as long as the dispensing and administrating and any authorization and approvals are consistent with the provider contract and issuer’s medical and payment policies.

If you believe an insurance company has failed to comply with RI Gen L § 27-18-33.3., you can file a complaint with Rhode Island’s Department of Insurance.

Great news – Texas has enacted a law restricting or prohibiting white bagging.

The Texas law states that an insurer may not, for enrollees with chronic, complex, rare, or life-threatening conditions, require clinician-administered drugs to be dispensed only by certain pharmacies if the drug is otherwise covered. Additionally, the insurer may not require that an in-network provider bill for or be reimbursed for delivery and administration under the pharmacy benefit instead of medical beenfit without written consent from the patient and written attestation by the health care provider that a delay in administration would not put the patient’s health at increased risk.

If you believe an insurance company has failed to comply with § 1369.764, you can file a complaint with Texas’s Department of Insurance.

The state of California has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Colorado has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Connecticut has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Delaware has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Florida has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Georgia has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Hawaii has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Illinois has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Indiana has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Iowa has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Kansas has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Kentucky has not yet enacted government price-setting legislation reform. Contact your state legislators and ask them to protect infusion center reimbursement from this harmful policy.

The state of Maine has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Maryland has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Massachusetts has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Michigan has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Missouri has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Montana has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Nevada has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of New Hampshire has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of New Jersey has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of New Mexico has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of New York has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of North Carolina has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Pennsylvania has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of South Carolina has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of South Dakota has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Tennessee has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Utah has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

Great news – Vermont has enacted a law restricting or prohibiting white bagging.

The Vermont law states that a health insurer or PBM may not require that a pharmacy designated by the insurer or PBM dispense a medication directly to a health care setting for a provider to administer to the patient.

If you believe an insurance company has failed to comply with 8 V.S.A. § 4089j, you can file a complaint with Vermont’s Department of Insurance.

Great news – Virginia has enacted a law restricting or prohibiting white bagging.

The Virginia law states that a health insurer or PBM cannot prohibit anyone receiving pharmacy benefits, including specialty pharmacy benefits, from selecting the pharmacy of their choice, including nonpreferred or nonparticipating providers.

If you believe an insurance company has failed to comply with § 38.2-3407.7. Pharmacies; freedom of choice, you can file a complaint with Virgnia’s Department of Insurance.

The state of Washington has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of West Virginia has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Wisconsin has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Wyoming has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

The state of Arizona has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.

Great news – Alaska has enacted a law restricting or prohibiting white bagging.

The law (Sec. 21.27.951) states that if medical necessity criteria are met, an insurer or PBM may not condition, deny, restrict, or refuse to authorize or refuse to approve a provider for a clinician-administered drug because the provider obtained the drug from a pharmacy that is not an insurer’s network pharmacy or a PBM’s network pharmacy. Insurers and PBMs are also prohibited from refusing to authorize, approve, or pay a provider for providing covered clinician-administered drugs to a patient 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.

If you believe an insurance company has failed to comply with Sec. 21.27.951, you can file a complaint with Alaska’s Department of Insurance.

The state of Alabama has yet to prohibit or restrict white-bagging mandates. Contact your state legislators and ask for their support.