Maryland 2022 Regular Session

Maryland House Bill HB1006 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4	4	[Brackets] indicate matter deleted from existing law.
5	5	hb1006
6	6
7	7	HOUSE BILL 1006
8	8	J5 2lr1851
9	9
10	10	By: Delegate Kipke
11	11	Introduced and read first time: February 10, 2022
12	12	Assigned to: Health and Government Operations
13	13
14	14	A BILL ENTITLED
15	15
16	16	AN ACT concerning 1
17	17
18	18	Pharmacy Benefits Managers – Network Adequacy, Credentialing, and 2
19	19	Reimbursement 3
20	20
21	21	FOR the purpose of requiring a pharmacy benefits manager or purchaser to maintain a 4
22	22	reasonably adequate and accessible network of pharmacies; prohibiting a pharmacy 5
23	23	benefits manager or purchaser from requiring a pharmacy or pharmacist to obtain 6
24	24	or maintain certain accreditation, certification, or credentialing as a condition for 7
25	25	participating in the pharmacy benefits manager’s or purchaser’s network; altering 8
26	26	certain reimbursement requirements for pharmacy benefits managers and 9
27	27	purchasers; authorizing a pharmacy or pharmacist to decline to dispense a 10
28	28	prescription drug or provide a pharmacy service if reimbursement will be less than 11
29	29	the pharmacy acquisition cost; and generally relating to pharmacy benefits 12
30	30	managers. 13
31	31
32	32	BY adding to 14
33	33	Article – Insurance 15
34	34	Section 15–1611.2 16
35	35	Annotated Code of Maryland 17
36	36	(2017 Replacement Volume and 2021 Supplement) 18
37	37
38	38	BY repealing and reenacting, with amendments, 19
39	39	Article – Insurance 20
40	40	Section 15–1628 and 15–1628.3 21
41	41	Annotated Code of Maryland 22
42	42	(2017 Replacement Volume and 2021 Supplement) 23
43	43
44	44	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 24
45	45	That the Laws of Maryland read as follows: 25
46	46
47	47	Article – Insurance 26
48	48	2 HOUSE BILL 1006
49	49
50	50
51	51	15–1611.2. 1
52	52
53	53	(A) SUBJECT TO SUBSECTION (B) OF THIS SECTION, A PHARMACY BENEFITS 2
54	54	MANAGER OR PURCHASER SHALL MAINTAIN A REA SONABLY ADEQUATE AND 3
55	55	ACCESSIBLE PHARMACY BENEFITS MANAGER OR PURCHASER NETWORK 4
56	56	CONSISTING OF CONTRA CTED PHARMACIES THAT PROVIDE CONVENI ENT PATIENT 5
57	57	ACCESS TO PHARMACY S ERVICES. 6
58	58
59	59	(B) (1) THE COMMISSIONER SHALL ES TABLISH CRITERIA FOR 7
60	60	DETERMINING THE ADEQUACY OF A PH ARMACY BENEFITS MANA GER’S OR 8
61	61	PURCHASER ’S NETWORK THAT INCLUDE S: 9
62	62
63	63	(I) A DETERMINATION OF T HE PURCHASERS THAT C ONTRACT 10
64	64	WITH THE PHARMACY BENEFITS MANAGER AND GEOGRAPH IC LOCATION IN WHICH 11
65	65	THE PURCHASERS OFFER COVERAGE FOR PRESCRI PTION DRUG BENEFITS ; 12
66	66
67	67	(II) A CALCULATION FOR DE TERMINING THE REASONABLE 13
68	68	DISTANCE FROM A PATI ENT’S HOME TO A CONTRACTED PHAR MACY; AND 14
69	69
70	70	(III) A REVIEW OF COMPENSATION PROG RAMS TO ENSURE THAT 15
71	71	THE REIMBURSEMENT PA ID TO PHARMACIES AND PHARMACISTS FOR PHAR MACY 16
72	72	SERVICES IS FAIR AND REASONABLE . 17
73	73
74	74	(2) A MAIL ORDER PHARMACY MAY NOT BE INCLUDED IN A 18
75	75	DETERMINATION OF A P HARMACY BENEFITS MAN AGER’S OR PURCHASER ’S 19
76	76	NETWORK ADEQUACY . 20
77	77
78	78	(C) THE COMMISSIONER MAY ADOP T REGULATIONS TO CAR RY OUT THIS 21
79	79	SECTION. 22
80	80
81	81	15–1628. 23
82	82
83	83	(a) (1) At the time of entering into a contract with a pharmacy or a pharmacist, 24
84	84	and at least 30 working days before any contract change, a pharmacy benefits manager 25
85	85	shall disclose to the pharmacy or pharmacist: 26
86	86
87	87	(i) the applicable terms, conditions, and reimbursement rates; 27
88	88
89	89	(ii) the process and procedures for verifying pharmacy benefits and 28
90	90	beneficiary eligibility; 29
91	91
92	92	(iii) the dispute resolution and audit appeals process; and 30
93	93	HOUSE BILL 1006 3
94	94
95	95
96	96	(iv) the process and procedures for verifying the prescription drugs 1
97	97	included on the formularies used by the pharmacy benefits manager. 2
98	98
99	99	(2) (i) This paragraph does not apply to a requirement that a specialty 3
100	100	pharmacy obtain national certification to be considered a specialty pharmacy in a pharmacy 4
101	101	benefits manager’s or [carrier’s] PURCHASER ’S network. 5
102	102
103	103	(ii) For purposes of credentialing a pharmacy or a pharmacist as a 6
104	104	condition for participating in a pharmacy benefits manager’s OR PURCHASER ’S network 7
105	105	[for a carrier], the pharmacy benefits manager OR PURCHASER may not: 8
106	106
107	107	1. require a pharmacy or pharmacist to: 9
108	108
109	109	A. renew credentialing more frequently than once every 3 10
110	110	years; or 11
111	111
112	112	B. OBTAIN OR MAINTAIN ACCREDITATION , 12
113	113	CERTIFICATION , OR CREDENTIALING THA T IS INCONSISTENT WI TH, MORE 13
114	114	STRINGENT THAN , OR IN ADDITION TO STATE REQUIREMENTS FO R LICENSURE OR 14
115	115	RELEVANT FEDERAL OR STATE STANDARDS ; OR 15
116	116
117	117	2. charge a pharmacy or pharmacist a fee for the initial 16
118	118	credentialing or renewing credentialing. 17
119	119
120	120	(b) (1) Each contract form or an amendment to a contract form between a 18
121	121	pharmacy benefits manager and a pharmacy may not become effective unless at least 30 19
122	122	days before the contract form or amendment to the contract form is to become effective, the 20
123	123	pharmacy benefits manager files an informational filing with the Commissioner in the 21
124	124	manner required by the Commissioner that includes a copy of the contract form or 22
125	125	amendment to the contract form. 23
126	126
127	127	(2) The Commissioner is not required to review the informational filing to 24
128	128	evaluate whether a contract form or amendment to a contract form is in violation of this 25
129	129	subtitle at the time the informational filing is made. 26
130	130
131	131	(3) The Commissioner may review and disapprove a cont ract form or 27
132	132	amendment to a contract form at any time after the contract form or amendment to the 28
133	133	contract form has been submitted as part of an informational filing. 29
134	134
135	135	(C) THE COMMISSIONER MAY USE A CONTRACT FILED UND ER SUBSECTION 30
136	136	(B) OF THIS SECTION IN M AKING A DETERMINATIO N OF WHETHER A PHARMAC Y 31
137	137	BENEFITS MANAGER ’S OR PURCHASER ’S NETWORK IS ADEQUATE AS REQUIRED 32
138	138	UNDER § 15–1611.2 OF THIS SUBTITLE. 33
139	139
140	140	15–1628.3. 34
141	141	4 HOUSE BILL 1006
142	142
143	143
144	144	(a) A pharmacy benefits manager or a [carrier] PURCHASER may not directly or 1
145	145	indirectly charge a contracted pharmacy, or hold a contracted pharmacy responsible for, a 2
146	146	fee or performance–based reimbursement related to the adjudication of a claim or an 3
147	147	incentive program THAT IS NOT SPECIFIC ALLY ENUMERATED BY T HE PHARMACY 4
148	148	BENEFITS MANAGER OR PURCHASER AT THE TIM E OF CLAIM PROCESSING . 5
149	149
150	150	(b) A pharmacy benefits manager or [carrier] PURCHASER may not make or 6
151	151	allow any reduction in payment for pharmacy services by a pharmacy benefits manager or 7
152	152	[carrier] PURCHASER or directly or indirectly reduce a payment for a pharmacy service 8
153	153	under a reconciliation process to an effective rate of reimbursement, including generic 9
154	154	effective rates, brand effective rates, direct and indirect remuneration fees, or any other 10
155	155	reduction or aggregate reduction of payments. 11
156	156
157	157	(C) IF THE AMOUNT REIMBUR SED BY A PHARMACY BE NEFITS MANAGER OR 12
158	158	PURCHASER FOR A PRESCRIPTION D RUG OR PHARMACY SERV ICE IS LESS THAN THE 13
159	159	PHARMACY ACQUISITION COST FOR THE SAME PR ESCRIPTION DRUG OR PHARM ACY 14
160	160	SERVICE, THE PHARMACY OR PHAR MACIST MAY DECLINE T O DISPENSE THE 15
161	161	PRESCRIPTION DRUG OR PROVIDE THE PHARMACY SERVICE TO A BENEFIC IARY. 16
162	162
163	163	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 17
164	164	policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 18
165	165	after January 1, 2023. 19
166	166
167	167	SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 20
168	168	January 1, 2023. 21