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1995 SESSION

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HB 2490 Pharmacies; freedom of choice under health maintenance organization.

Introduced by: George H. Heilig, Jr. | all patrons    ...    notes | add to my profiles

SUMMARY:

Health maintenance organizations; pharmacies; freedom of choice. Requires nonparticipating pharmacy providers who desire to obtain reimbursement for pharmacy services from an HMO to agree in writing to accept the HMO's reimbursement rate for participating providers as payment in full. The written agreement must be received by the HMO before the pharmacy renders a covered pharmacy service and receives any payment from an individual covered under an HMO plan. The bill further states that individuals covered under an HMO plan who receive pharmacy benefits from a nonparticipating provider are not responsible for any payment in excess of the copayment and the plan's allowable reimbursement for participating providers. Finally, the bill repeals the ancillary service provider freedom of choice statute applicable to HMOs.


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