Health Insurance State Laws:
Coverage & Navigation

The first chart highlights the state laws related to health insurance coverage and navigation, including oral chemotherapy, step therapy, clinical trials, second opinions, and more. The second chart covers white bagging, brown bagging, and site of service provisions regarding the delivery and administration of specialty drugs. Check back often, as these charts are updated frequently.

If you have a self-funded plan, certain state laws may not apply. For information on how to determine if your plan is self-funded, see our blog post.

If you don't find what you're looking for, see our other Charts of Health Insurance State Laws:

For more health insurance information, visit our Health Insurance Materials & Resources. If you are looking for information on Medicare or Medicaid, return to the main state laws page.

StateOral Chemotherapy Parity Law*Clinical Trials Coverage LawLaws Limiting Surprise BillingWho Runs External Appeals ProcessCoverage of Second Medical OpinionsDistinguishes Out-of-Network Second OpinionsHealth Insurance Coverage for Screening
ALABAMARun by HHShttps://externalappeal.cms.gov/ferpportal/
ALASKA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://www.akleg.gov/basis/Bill/Text/29?Hsid=SB0142ZRequires insurers to cover routine patient care costs from approved clinical trials related to cancer.Run by State Agencyhttps://www.commerce.alaska.gov/web/ins/Consumers/Health/ExternalHealthcareReview.aspx
ARIZONA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://www.azleg.gov/legtext/51leg/2r/laws/0255.pdfRequires insurers to cover certain patient costs from approved clinical trials related to cancer.All carehttps://apps.azleg.gov/BillStatus/GetDocumentPdf/453367Run by State Agencyhttps://difi.az.gov/sites/default/files/Consumer_Guide_to_Health_Care_Appeals_202110.pdf
ARKANSAS
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
http://www.arkleg.state.ar.us/assembly/2017/2017R/Bills/HB1592.pdfRun by State Agencyhttps://www.insurance.arkansas.gov/site/assets/files/2007/er_faq.pdf
CALIFORNIA
Caps out-of-pocket costs at $250 for a 30-day supply of oral chemo.
https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=INS&division=2.&title=&part=2.&chapter=1.&article=1.Requires insurers to cover routine patient care costs from approved clinical trials related to cancer.All carehttps://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201520160AB72Run by State Agencyhttp://www.insurance.ca.gov/01-consumers/150-other-prog/001-ahb/appeal-process.cfmOnly applies to disability insurers covering hospital, medical, or surgical expenses. Insurers describe what constitutes as necessary & appropriate for second medical opinion.https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=INS§ionNum=10123.67.Yes, Must cover outside network second opinion if there's no participating in-network providers that meet standards
COLORADO
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://legiscan.com/CO/text/HB1202/2010Requires insurers to cover routine patient care costs from clinical trials recommended by a treating physician.All carehttp://leg.colorado.gov/sites/default/files/2019a_1174_signed.pdfRun by State Agencyhttps://drive.google.com/file/d/0BwguXutc4vbpMlZYWkxjWll2TGM/viewDoes not explicitly require insurance companies to provide coverage, but requires clear and complete statement if it does allow for second opinion.https://casetext.com/statute/colorado-revised-statutes/title-10-insurance/health-care-coverage/article-16-health-care-coverage/part-7-consumer-protection-standards-act-for-the-operation-of-managed-care-plans/section-10-16-705-requirements-for-carriers-and-participating-providers-definitions
CONNECTICUT
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/connecticut/2012/title-38a/chapter-700c/section-38a-504Requires insurers to cover routine patient care costs from approved clinical trials related to cancer.All carehttps://www.cga.ct.gov/current/pub/chap_700c.htmRun by State Agencyhttps://portal.ct.gov/cid/-/media/CID/1_ConsumerResources/External-Review-Program-FAQs.pdfrequires health insurance to provide coverage for baseline mammograms for: individuals younger than 35 if they have an increased risk of breast care or individuals 35-39. It also requires mammograms every year be covered for individuals over 40 and those younger than 40 who are at increased risk of breast cancer. It also requires health insurance cover to cover diagnostic mammogram, ultrasounds, or magnetic resonance imaging (MRI).https://www.cga.ct.gov/2022/ACT/PA/PDF/2022PA-00090-R00SB-00358-PA.PDF
DELAWARE
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://delcode.delaware.gov/title18/c033/sc01/index.shtmlRequires insurers to cover routine patient care costs from approved clinical trials related to life threatening diseases.All carehttps://legis.delaware.gov/SessionLaws/Chapter?id=19067Run by State Agencyhttps://insurance.delaware.gov/divisions/consumerhp/ihcap/
*DISTRICT OF COLUMBIA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://code.dccouncil.gov/us/dc/council/code/sections/31-2995.02Requires insurers to cover routine patient care costs from approved clinical trials.Run by State Agencyhttps://dhcf.dc.gov/publication/grievancesappeals-0
FLORIDA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
http://www.flsenate.gov/Session/Bill/2013/301/BillText/c1/PDFAll carehttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0627/Sections/0627.64194.htmlRun by HHShttps://externalappeal.cms.gov/ferpportal/Right to second medical opinion in instances where subscriber disputes organization/physician's opinion of reasonbleness or necessity.http://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0641/Sections/0641.51.htmlOrganizations need to develop and maintain policy to determine when exceptional referrals to out-of-network specially qualified providers . . . All financial arrangements shall be agreed to prior to services being rendered
GEORGIA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/georgia/2022/title-33/chapter-24/article-1/section-33-24-56-5/Requires clinical trial sponsors to provide potential patients with information around costs at the time of informed consentAll carehttps://rules.sos.ga.gov/gac/120-2-106Run by HHShttps://externalappeal.cms.gov/ferpportal/
HAWAII
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/hawaii/2013/title-24/chapter-432/section-432-1-616/Run by State Agencyhttps://cca.hawaii.gov/ins/external-review-of-health-plan-disputes/
IDAHORequires insurers to cover routine patient care costs from approved clinical trials.Run by State Agencyhttps://doi.idaho.gov/consumers/health-insurance/external-review/
ILLINOIS
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo, with no additional treatment restrictions.
https://www.ilga.gov/legislation/ilcs/ilcs4.asp?DocName=021500050HArt.+XXII&ActID=1249&ChapAct=215%C2%A0ILCS%C2%A05%2F&ChapterID=22&ChapterName=INSURANCE&SectionID=52304&SeqStart=107000000&SeqEnd=108700000&ActName=IRequires insurers to cover routine patient care costs from approved clinical trials related to cancer.All carehttp://www.ilga.gov/legislation/publicacts/fulltext.asp?Name=096-1523Run by State Agencyhttps://idoi.illinois.gov/consumers/file-an-external-review.htmlBenefit Plans under minimum benefits include second surgical opinions.https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1254&ChapterID=22Requires baseline mammogram women 35-39, annual mammograms for age 40 and older, and women under 40 years of age and having a family history of breast cancer, prior personal history of breast cancer, positive genetic testing, or other risk factors.https://www.ilga.gov/legislation/ilcs/fulltext.asp?DocName=021500050K356g
INDIANA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/indiana/2022/title-27/article-13/chapter-7/section-27-13-7-20/Requires insurers to cover routine patient care costs from clinical trials.All care (except ER)http://iga.in.gov/legislative/2020/bills/house/1004Run by State Agencyhttps://www.in.gov/idoi/3008.htmHMO enrollees may obtain second medical opinions from appropriate participating providers.http://iga.in.gov/legislative/laws/2020/ic/titles/027#27-13-37-5
IOWA
Requires insurers to provide the same coverage benefits for oral chemo as those for intravenous chemo.
https://www.legis.iowa.gov/docs/code/514C.24.pdfRequires insurers to cover routine patient care costs from approved clinical trials related to cancer that are recommended by two physicians.ER onlyhttps://www.legis.iowa.gov/docs/code/514C.16.pdfRun by State Agencyhttps://iid.iowa.gov/external-review
KANSAS
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://www.ksrevisor.org/statutes/chapters/ch40/040_002_0184.htmlRequires insurers to cover routine patient care costs from clinical trials related to cancer that are recommended by a treating physician.Run by State Agencyhttps://insurance.ks.gov/documents/department/publications/independent-medical-review.pdf
KENTUCKY
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://www.lawserver.com/law/state/kentucky/ky-statutes/kentucky_statutes_304-17a-172Requires insurers to cover routine patient care costs from approved clinical trials related to cancer.Run by State Agencyhttp://insurance.ky.gov/ppc/Documents/abdappeal071217.pdfRequires an insurer to cover cost of second opinion of participating health care providerhttps://apps.legislature.ky.gov/law/statutes/statute.aspx?id=17430
LOUISIANA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/louisiana/2022/revised-statutes/title-22/rs-22-999-1/Requires insurers to cover patient care costs from approved clinical trials related to cancer.Run by State Agencyhttps://www.ldi.la.gov/docs/default-source/documents/publicaffairs/consumerpublications/understanding-your-healthcare-rights.pdf?sfvrsn=45277652_22
MAINE
Requires insurers to provide coverage for oral chemo that is equivalent to that for intravenous chemo.
http://www.mainelegislature.org/legis/bills/bills_126th/chapters/PUBLIC449.aspRequires insurers to cover routine patient care costs from approved clinical trials related to a life-threatening illness and recommended by a treating physician.All carehttp://legislature.maine.gov/legis/bills/bills_129th/billtexts/HP150101.aspRun by State Agencyhttps://www.maine.gov/pfr/insurance/consumers/long-term-care-insurance/complaints-appeals
MARYLAND
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/maryland/2022/insurance/title-15/subtitle-8/section-15-846/Requires insurers to cover patient care costs from approved clinical trials related to cancer.All carehttp://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=ghg§ion=19-710&enactments=falseRun by State Agencyhttps://insurance.maryland.gov/Consumer/Pages/AppealsAndGrievances.aspx
MASSACHUSETTS
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://malegislature.gov/Laws/GeneralLaws/PartI/TitleIV/Chapter32A/Section17KRequires insurers to cover patient care costs from approved clinical trials related to cancer.All carehttps://www.mass.gov/files/documents/2018/03/14/2015-ctr-out-of-network.pdfRun by State Agencyhttps://www.mass.gov/request-an-external-review-of-a-health-insurance-decision
MICHIGAN
Requires insurers to either cover oral chemo at a rate no higher than that for intravenous chemo or cap out-of-pocket expenses at $250 for a 30-day supply of oral chemo.
http://www.legislature.mi.gov/documents/2023-2024/publicact/pdf/2023-PA-0170.pdfAll carehttps://www.legislature.mi.gov/(S(htpfz3t3z35rmjkrhaqvdm1t))/mileg.aspx?page=getObject&objectName=mcl-368-1978-18Run by State Agencyhttps://difs.state.mi.us/Complaints/ExternalReview.aspx
MINNESOTA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://www.revisor.mn.gov/statutes/cite/62A.3075Requires insurers to cover routine patient care costs from clinical trials related to cancer and recommended by a treating physician.All carehttps://www.revisor.mn.gov/statutes/cite/62Q.556Run by State Agencyhttp://mn.gov/commerce-stat/pdfs/external-review-appeal.pdfSecond opinions needed in all minimum benefits health plans for surgeries exceeding $500, HMO enrollees eligibe in cases of chemical dependency and mental healthhttps://www.revisor.mn.gov/statutes/cite/62E.06 https://www.revisor.mn.gov/statutes/cite/62D.103
MISSISSIPPI
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://legiscan.com/MS/text/HB952/2015All carehttps://legiscan.com/MS/text/HB374/id/734015/Mississippi-2013-HB374-Enrolled.htmlRun by State Agencyhttps://www.mid.ms.gov/healthcare/external-review.aspx
MISSOURI
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo or cap out-of-pocket expenses at $75 for a 30-day supply of oral chemo.
https://legiscan.com/MO/text/SB668/id/983931Requires insurers to cover routine patient care costs from approved clinical trials related to cancer.ER onlyhttps://revisor.mo.gov/main/OneSection.aspx?section=376.690Run by State Agencyhttps://insurance.mo.gov/consumers/health/externalreviewprocess.phpAllows enrollees to seek second medical opinion at no additional costhttps://revisor.mo.gov/main/OneSection.aspx?section=354.207&bid=19039&hl=
MONTANARequires insurers to cover routine patient care costs from approved clinical trials related to cancer.ER onlyhttps://leg.mt.gov/bills/mca/title_0330/chapter_0020/part_0230/section_0020/0330-0020-0230-0020.htmlRun by State Agencyhttps://benefits.mt.gov/enrollment-and-claims/appealing-unreimbursed-claims
NEBRASKA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/nebraska/2022/chapter-44/statute-44-7-104/ER onlyhttps://custom.statenet.com/public/resources.cgi?id=ID:bill:NE2019000L997&cuiq=05748d3c-33bd-57a1-9a02-5f138328b4b9&client_md=7384d79ae7f15dfb68295a6cdef5e66e&mode=current_textRun by State Agencyhttps://doi.nebraska.gov/sites/doi.nebraska.gov/files/doc/out13261.pdf
NEVADA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo and cap out-of-pocket expenses at $100 per oral chemo prescription.
https://legiscan.com/NV/text/SB266/2013Requires insurers to cover patient care costs from approved clinical trials related to cancer.ER onlyhttps://www.leg.state.nv.us/nrs/nrs-439B.html#NRS439BSec745Run by State Agencyhttps://adsd.nv.gov/Programs/CHA/ExtRev/External_Review/
NEW HAMPSHIRE
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://legiscan.com/NH/text/HB508/2015Requires insurers to cover routine patient care costs from approved clinical trials related to cancer.All carehttps://www.gencourt.state.nh.us/rsa/html/XXX/329/329-31-b.htmRun by State Agencyhttps://www.nh.gov/insurance/consumers/appeals.htmEmployer's insurance carrier or self-insurer provides an employee with reasonable access to second medical opinion, inside or outside the programhttps://www.gencourt.state.nh.us/rsa/html/XXIII/281-A/281-A-23-a.htm
NEW JERSEY
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/new-jersey/2022/title-17/section-17-48-6jj/Requires insurers to cover routine patient care costs from approved clinical trials related to cancer.All carehttps://www.state.nj.us/dobi/division_consumers/insurance/outofnetwork.htmlRun by State Agencyhttps://www.state.nj.us/dobi/division_consumers/insurance/appealcomplaintguide.pdfIn addition to second opinion, statute requires insurance program to cover third surgical opinions if second opinion does not confirm medical advisability. Applies to surgery second/third opinions.https://casetext.com/statute/new-jersey-statutes/title-17-corporations-and-institutions-for-finance-and-insurance/chapter-1748e/section-1748e-33-second-third-surgical-opinions
NEW MEXICO
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/new-mexico/2021/chapter-59a/article-23/section-59a-23-7-10/Requires insurers to cover routine patient care costs from approved clinical trials related to cancer.All carehttps://www.nmlegis.gov/Sessions/19 Regular/final/SB0337.pdfRun by State Agencyhttps://www.osi.state.nm.us/pages/bureaus/mhcb/resources/consumer-guide-to-filing-an-appeal
NEW YORK
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/new-york/2022/isc/article-32/3221/All carehttps://www.nysenate.gov/legislation/laws/FIS/A6Run by State Agencyhttps://www.dfs.ny.gov/complaints/file_external_appealRequires contracts for covered services to provide coverage for second medical opinion.https://www.nysenate.gov/legislation/laws/ISC/4303 https://www.nysenate.gov/legislation/laws/ISC/3216Yes, In the case of a contract that requires, or provides financial incentives for, the covered person to receive covered services from health care providers participating in a provider network maintained by or under contract with the corporation, the contract shall include coverage for a second medical opinion from a non-participating specialist, including but not limited to a specialist affiliated with a specialty care center for the treatment of cancer, when the attending physician provides a written referral to a non-participating specialist, at no additional cost to the covered person beyond what such covered person would have paid for services from a participating appropriate specialist.Requires large group health insurance to cover baseline mammograms for women aged 35-39. Additionally, requires mammograms for women at any age who are at an increased risk of breast cancer because they have a prior history of breast cancer, or they have a first degree relative with breast cancer. The law also removes cost-sharing for women in need of imaging tests other than standard mammograms - such as diagnostic mammograms, breast ultrasounds, and breast magnetic resonance imaging (MRI) for the detection of breast cancer.https://www.health.ny.gov/diseases/cancer/breast/nys_breast_cancer_faqs.htm
NORTH CAROLINARequires insurers to cover patient care costs from approved Phase II, III and IV clinical trials related to life-threatening medical conditions.ER onlyhttps://www.ncleg.gov/EnactedLegislation/Statutes/HTML/ByArticle/Chapter_58/Article_3.htmlRun by State Agencyhttps://www.ncdoi.gov/consumers/health-insurance/health-claim-denied/request-external-review
NORTH DAKOTA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://www.legis.nd.gov/assembly/63-2013/interim/15-0117-04000.pdfRun by State Agencyhttps://www.nd.gov/ndins/health
OHIO
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo or cap out-of-pocket expenses at $100 per oral chemo prescription.
https://codes.ohio.gov/ohio-revised-code/section-3923.85Requires insurers to cover routine patient care costs from approved clinical trials related to cancer.All carehttps://search-prod.lis.state.oh.us/solarapi/v1/general_assembly_133/bills/hb388/EN/05/hb388_05_EN?format=pdfRun by State Agencyhttps://insurance.ohio.gov/consumers/health/understanding-health-coverage-external-review-appeal
OKLAHOMA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo or cap out-of-pocket expenses at $100 per oral chemo prescription.
https://oksenate.gov/sites/default/files/2019-12/os36.pdfRun by State Agencyhttps://www.oid.ok.gov/consumers/external-review-process/
OREGON
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://oregon.public.law/statutes/ors_743a.068Requires insurers to cover routine patient care costs from approved clinical trials.All carehttps://www.oregonlegislature.gov/bills_laws/ors/ors743b.htmlRun by State Agencyhttps://dfr.oregon.gov/insure/health/understand/coverage/Pages/if-your-claim-was-denied.aspxEnrollee may obtain second medical opinion within network if insurer offers a health plan benefit that requires specialty care serviceshttps://www.oregonlegislature.gov/bills_laws/ors/ors743B.htmlYes, health plans must allow enrolle to obtain opinion or consultation from similarly qualified physician who is not a network provider; plan may not impose charge greater than cost that the enrollee would otherwise pay
PENNSYLVANIA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://www.legis.state.pa.us/cfdocs/Legis/LI/uconsCheck.cfm?txtType=HTM&yr=2016&sessInd=0&smthLwInd=0&act=0073.ER onlyhttp://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/028/chapter9/subchapHtoc.html&d=reduceRun by HHShttps://externalappeal.cms.gov/ferpportal/
*PUERTO RICORun by State Agencyhttp://ocs.gobierno.pr/ocspr/index.php/seguros-de-salud/370
RHODE ISLAND
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
http://webserver.rilin.state.ri.us/Statutes/title27/27-18/27-18-80.htmRequires insurers to cover routine patient care costs from approved clinical trials related to cancer.All carehttp://webserver.rilin.state.ri.us/BillText/BillText18/SenateText18/S2077Aaa.pdfRun by State Agencyhttp://www.eohhs.ri.gov/Consumer/ConsumerInformation/Appeals.aspxInsurance benefits must cover second and third medical opinionshttp://webserver.rilegislature.gov//Statutes/TITLE27/27-39/27-39-2.HTM http://webserver.rilegislature.gov//Statutes/TITLE27/27-39/27-39-3.HTM
SOUTH CAROLINARun by State Agencyhttps://doi.sc.gov/DocumentCenter/View/2554/Patients-Guide-to-External-Review?bidId=
SOUTH DAKOTA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://www.billtrack50.com/billdetail/565089Run by State Agencyhttps://dlr.sd.gov/insurance/external_review_health_major_medical.aspx
TENNESSEERequires insurers to cover routine patient care costs from approved clinical trials related to cancer that are recommended by a treating physician.Run by State Agencyhttps://www.tn.gov/commerce/tenncare-oversight/mco-dispute-resolution/independent-review-process.html
TEXAS
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/texas/2017/insurance-code/title-8/subtitle-e/chapter-1369/Requires insurers to cover routine patient care costs from approved clinical trials related to a life-threatening condition.All carehttps://www.tdi.texas.gov/medical-billing/providers.htmlRun by HHShttps://externalappeal.cms.gov/ferpportal/
UTAH
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://le.utah.gov/~2013/bills/sbillint/sb0189.pdfRun by State Agencyhttps://insurance.utah.gov/consumer/health/independent-review
VERMONT
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://legislature.vermont.gov/statutes/section/08/107/04100hRequires insurers to cover routine patient care costs from approved clinical trials related to cancer.ER onlyhttps://legislature.vermont.gov/statutes/fullchapter/33/065Run by State Agencyhttps://dfr.vermont.gov/consumers/file-complaint/insurance/healthcare-external-appeal
VIRGINIA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.lis.virginia.gov/vacode/title38.2/chapter34/section38.2-3407.18/Requires insurers to cover patient care costs from approved clinical trials related to cancer.All carehttps://law.lis.virginia.gov/vacode/title38.2/chapter34/section38.2-3445.01/Run by State Agencyhttps://scc.virginia.gov/pages/External-Review-(1)
WASHINGTON
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://app.leg.wa.gov/rcw/default.aspx?cite=41.05.175Requires insurers to cover routine patient care costs from approved clinical trials related to cancer.All carehttps://app.leg.wa.gov/RCW/default.aspx?cite=48.49.020Run by State Agencyhttps://www.insurance.wa.gov/appealing-health-insurance-denialHealth service carriers must provide enrolleess access to a second medical opinionhttps://app.leg.wa.gov/RCW/default.aspx?cite=48.43.515
WEST VIRGINIA
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://code.wvlegislature.gov/33-15-4l/Requires insurers to cover patient care costs from approved Phase II, III and IV clinical trials related to cancer.ER onlyhttp://www.wvlegislature.gov/WVCODE/code.cfm?chap=33&art=25ARun by State Agencyhttps://www.wvinsurance.gov/portals/0/pdf/External Review Request Form 2-4-2016.pdfManaged care plans must provide accesss to second opinion for enrolleeshttps://code.wvlegislature.gov/33-25C-4/
WISCONSIN
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://docs.legis.wisconsin.gov/2013/related/acts/186Requires insurers to cover patient care costs from approved clinical trials related to cancer.Run by HHShttps://externalappeal.cms.gov/ferpportal/Defined network plans are required to provide coverage for second opinionshttps://docs.legis.wisconsin.gov/statutes/statutes/609/22
WYOMING
Requires insurers to cover oral chemo at a rate no higher than that for intravenous chemo.
https://law.justia.com/codes/wyoming/2022/title-26/chapter-20/article-6/section-26-20-601/Requires insurers to cover routine patient care costs from approved Phase II, III and IV clinical trials related to cancer.Run by State Agencyhttps://doi.wyo.gov/consumers/iro
GUAMRun by HHShttps://externalappeal.cms.gov/ferpportal/
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White Bagging, Brown Bagging, and Site of Service State Laws

Bagging refers to the way that specialty drugs are being delivered to a patient. White bagging is when a specialty pharmacy sends the drugs directly to the provider who will administer the drug. Brown bagging is when the patient goes to the specialty pharmacy to pick up the drug or gets the drug delivered to them, and then the patient brings the drug to the provider for administration. Site of service provisions refer to the location where specialty drugs are being administered to a patient.

StateType of State LawSummary of State Law
ALABAMAProhibits white bagginghttps://legiscan.com/AL/text/SB227/2021A pharmacy benefits manager cannot make a person buy pharmacy services only from a mail-order pharmacy or the pharmacy benefits manager's affiliate as a condition to get reimbursed.
ALASKA
ARIZONA
ARKANSASProhibits site of service provisions (only for hematology/oncology diagnoses)https://www.arkleg.state.ar.us/Home/FTPDocument?path=%2FACTS%2F2021R%2FPublic%2FACT1105.pdfA health care payor cannot make a person self-administer medicine if the provider should be the one giving it. When a health care provider determines that the provider should administer the medication, the health insurance company must pay for the cost of the medicine and its administration, even if it's not usually covered in the plan. A health care payor cannot prevent or limit a person from choosing an in-network pharmacy or pharmacist, as long as the pharmacist follows the terms of the manager's contract.
CALIFORNIA
COLORADO
CONNECTICUT
DELAWARE
*DISTRICT OF COLUMBIA
FLORIDAProhibits white bagginghttp://www.leg.state.fl.us/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=0600-0699/0626/Sections/0626.8825.htmlA pharmacy benefits manager cannot limit a patient's network to only affiliated pharmacies or require a patient to get the medication through the mail. For the in-person administration of the medication, a pharmacy benefits manager cannot require a patient to receive pharmacist services from an affiliated pharmacy or affiliated health care provider.
GEORGIA
HAWAII
IDAHO
ILLINOIS
INDIANA
IOWA
KANSAS
KENTUCKY
LOUISIANAProhibits white bagginghttps://legiscan.com/LA/text/SB191/2021A health insurance company cannot deny coverage or charge more for a physican-administered medicine if the physician provides the medicine from an out-of-network pharmacy.
MAINE
MARYLAND
MASSACHUSETTS
MICHIGAN
MINNESOTAProhibits brown bagging and site of service provisionshttps://www.revisor.mn.gov/laws/2023/0/Session+Law/Chapter/57/(1) A pharmacy benefits manager or insurance company cannot require a specialty pharmacy to provide a physician-administered drug to the patient for transport to the provider for administration of the drug and (2) a pharmacy benefit manager, health carrier, health care provider, or pharmacist cannot require and cannot deny the use of home infusion or use of another site for infusion for a phyician-adminstered drug when clinically appropriate.
MISSISSIPPI
MISSOURI
MONTANA
NEBRASKA
NEVADA
NEW HAMPSHIRE
NEW JERSEY
NEW MEXICO
NEW YORK
NORTH CAROLINA
NORTH DAKOTAProhibits white bagging, brown bagging, and site of service provisionshttps://www.ndlegis.gov/assembly/68-2023/regular/documents/23-1064-04000.pdf(1) A pharmacy benefits manager cannot require the use of, or charge more for not using, a mail-order pharmacy or pharmacy benefits manager affiliate. (2) A pharmacy benefits manager cannot require a designated pharmacy to deliver a medication to the patient for the patient to transport to the provider for administration. (3) A pharmacy benefits manager cannot require a designated pharmacy to deliver a medication drectly to the provider for administration. (4) A pharmacy benefits manager cannot require the use of a home infusion pharmacy to deliver physician-adminstered drugs to the patient in the patient's home.
OHIO
OKLAHOMA
OREGON
PENNSYLVANIA
*PUERTO RICO
RHODE ISLAND
SOUTH CAROLINA
SOUTH DAKOTA
TENNESSEEProhibits white bagginghttps://publications.tnsosfiles.com/acts/112/pub/pc1070.pdfA pharmacy benefits manager cannot (1) stop a patient from choosing a pharmacy of their choice, as long as it follows the rules and (2) give money or other incentives to a patient to persuade them to use a pharmacy that benefits the pharmacy benefits manager
TEXASProhibits white bagging for patients with a "chronic, complex, rare, or life-threatening medical conditionhttps://capitol.texas.gov/tlodocs/88R/billtext/pdf/HB01647F.pdf#navpanes=0Α health insurance company cannot (1) require a patient to get physician-administered drugs from only certain pharmacies or pharmacies in their network, (2) if the drug is covered, limit or deny coverage because the pharmacy is outside the health insurance company's network, and (3) charge a patient more due to their choice in pharmacy
UTAH
VERMONTProhibits white bagging and brown bagginghttps://legislature.vermont.gov/Documents/2022/Docs/ACTS/ACT131/ACT131%20As%20Enacted.pdfA pharmacy benefits manager cannot (1) require a pharmacy to give medicine to a patient for the patient to transport to the provider to be administered and (2) require a pharmacy deliver the medicine directly to a provider for administration
VIRGINIAProhibits brown bagging and sets standards for white bagginghttps://law.lis.virginia.gov/admincode/title18/agency110/chapter20/section275/(1) A pharmacy cannot deliver drugs directly to a patient if the drugs are intended to be transported by the patient to a health care facility for adminstration (2) A pharmacy can send certain medicines to another pharmacy or to a specific person allowed by the law, like a physician, but there are rules about how this process can be done.
WASHINGTON
WEST VIRGINIA
WISCONSIN
WYOMING
*GUAM
Last Updated1/18/2024

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