Maryland 2022 Regular Session

Maryland House Bill HB1008 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	hb1008
6	6
7	7	HOUSE BILL 1008
8	8	J5 2lr1853
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 and Purchasers – Beneficiary Choice of Pharmacy 2
19	19
20	20	FOR the purpose of prohibiting a pharmacy benefits manager or purchaser from prohibiting 3
21	21	a beneficiary from selecting a pharmacy or pharmacist of the beneficiary’s choosing, 4
22	22	denying a pharmacy or pharmacist the right to participate in a network, imposing 5
23	23	certain monetary advantages or penalties on a beneficiary, or requiring the use of a 6
24	24	mail–order pharmacy, under certain circumstances; requiring a pharmacy benefits 7
25	25	manager or purchaser that restricts participation in a geographical network to notify 8
26	26	all pharmacies in the geographic area of the opportunity to participate in the 9
27	27	network; authorizing a beneficiary, pharmacy, or pharmacist to maintain a cause of 10
28	28	action for violations of the requirements of this Act; and generally relating to 11
29	29	pharmacy benefits managers and purchasers. 12
30	30
31	31	BY repealing and reenacting, without amendments, 13
32	32	Article – Insurance 14
33	33	Section 15–1601(a), (c), (l), (m), (n), (o), (p), (q), and (s) 15
34	34	Annotated Code of Maryland 16
35	35	(2017 Replacement Volume and 2021 Supplement) 17
36	36
37	37	BY repealing 18
38	38	Article – Insurance 19
39	39	Section 15–1611.1 20
40	40	Annotated Code of Maryland 21
41	41	(2017 Replacement Volume and 2021 Supplement) 22
42	42
43	43	BY adding to 23
44	44	Article – Insurance 24
45	45	Section 15–1611.1 25
46	46	Annotated Code of Maryland 26
47	47	(2017 Replacement Volume and 2021 Supplement) 27
48	48	2 HOUSE BILL 1008
49	49
50	50
51	51	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 1
52	52	That the Laws of Maryland read as follows: 2
53	53
54	54	Article – Insurance 3
55	55
56	56	15–1601. 4
57	57
58	58	(a) In this subtitle the following words have the meanings indicated. 5
59	59
60	60	(c) “Beneficiary” means an individual who receives prescription drug coverage or 6
61	61	benefits from a purchaser. 7
62	62
63	63	(l) “Participating pharmacy contract” means a contract filed with the 8
64	64	Commissioner in accordance with § 15–1628(b) of this subtitle. 9
65	65
66	66	(m) “Pharmacist” has the meaning stated in § 12–101 of the Health Occupations 10
67	67	Article. 11
68	68
69	69	(n) “Pharmacy” has the meaning stated in § 12–101 of the Health Occupations 12
70	70	Article. 13
71	71
72	72	(o) “Pharmacy and therapeutics committee” means a committee established by a 14
73	73	pharmacy benefits manager to: 15
74	74
75	75	(1) objectively appraise and evaluate prescription drugs; and 16
76	76
77	77	(2) make recommendations to a purchaser regarding the selection of drugs 17
78	78	for the purchaser’s formulary. 18
79	79
80	80	(p) (1) “Pharmacy benefits management services” means: 19
81	81
82	82	(i) the procurement of prescription drugs at a negotiated rate for 20
83	83	dispensation within the State to beneficiaries; 21
84	84
85	85	(ii) the administration or management of prescription drug coverage 22
86	86	provided by a purchaser for beneficiaries; and 23
87	87
88	88	(iii) any of the following services provided with regard to the 24
89	89	administration of prescription drug coverage: 25
90	90
91	91	1. mail service pharmacy; 26
92	92
93	93	2. claims processing, retail network management, and 27
94	94	payment of claims to pharmacies for prescription drugs dispensed to beneficiaries; 28
95	95
96	96	3. clinical formulary development and management services; 29
97	97	HOUSE BILL 1008 3
98	98
99	99
100	100	4. rebate contracting and administration; 1
101	101
102	102	5. patient compliance, therapeutic intervention, and generic 2
103	103	substitution programs; or 3
104	104
105	105	6. disease management programs. 4
106	106
107	107	(2) “Pharmacy benefits management services” does not include any service 5
108	108	provided by a nonprofit health maintenance organization that operates as a group model, 6
109	109	provided that the service: 7
110	110
111	111	(i) is provided solely to a member of the nonprofit health 8
112	112	maintenance organization; and 9
113	113
114	114	(ii) is furnished through the internal pharmacy operations of the 10
115	115	nonprofit health maintenance organization. 11
116	116
117	117	(q) “Pharmacy benefits manager” means a person that performs pharmacy 12
118	118	benefits management services. 13
119	119
120	120	(s) “Purchaser” means a person that offers a plan or program in the State, 14
121	121	including the State Employee and Retiree Health and Welfare Benefits Program, that: 15
122	122
123	123	(1) provides prescription drug coverage or benefits in the State; and 16
124	124
125	125	(2) enters into an agreement with a pharmacy benefits manager for 17
126	126	the provision of pharmacy benefits management services. 18
127	127
128	128	[15–1611.1. 19
129	129
130	130	(a) This section applies only to a pharmacy benefits manager that provides 20
131	131	pharmacy benefits management services on behalf of a carrier. 21
132	132
133	133	(b) Except as provided in subsection (c) of this section, a pharmacy benefits 22
134	134	manager may not require that a beneficiary use a specific pharmacy or entity to fill a 23
135	135	prescription if: 24
136	136
137	137	(1) the pharmacy benefits manager or a corporate affiliate of the pharmacy 25
138	138	benefits manager has an ownership interest in the pharmacy or entity; or 26
139	139
140	140	(2) the pharmacy or entity has an ownership interest in the pharmacy 27
141	141	benefits manager or a corporate affiliate of the pharmacy benefits manager. 28
142	142
143	143	(c) A pharmacy benefits manager may require a beneficiary to use a specific 29
144	144	pharmacy or entity for a specialty drug as defined in § 15–847 of this title.] 30
145	145
146	146	15–1611.1. 31 4 HOUSE BILL 1008
147	147
148	148
149	149
150	150	(A) IN THIS SECTION, “CONTRACTED PROVIDER ” MEANS A PHARMACY OR 1
151	151	PHARMACIST THAT PARTICIPATES IN THE NETWORK OF A PHA RMACY BENEFITS 2
152	152	MANAGER OR PURCHASER THROUGH A PARTICIPATING PHARMA CY CONTRACT WITH 3
153	153	THE PHARMACY BENEFITS MA NAGER OR PURCHASER . 4
154	154
155	155	(B) UNLESS THE ENTITY CON TRACTS WITH AN OUTSIDE PHAR MACY OR 5
156	156	GROUP OF PHARMACIES TO PROVIDE PRESCRIPT ION DRUGS AND SERVIC ES, THIS 6
157	157	SECTION DOES NOT APPLY TO AN ENTITY THAT: 7
158	158
159	159	(1) HAS ITS OWN FACILITY ; 8
160	160
161	161	(2) EMPLOYS OR CONTRACTS WITH PHYSICIANS , PHARMACISTS , 9
162	162	NURSES, AND OTHER HEALTH CAR E PERSONNEL; AND 10
163	163
164	164	(3) DISPENSES PRESCRIPTI ON DRUGS FROM ITS OW N PHARMACY TO 11
165	165	ITS EMPLOYEES AND DE PENDENTS ENROLLED IN ITS HEALTH BENEFIT P LAN. 12
166	166
167	167	(C) A PHARMACY BENEFITS MA NAGER OR PURCHASER MAY NOT: 13
168	168
169	169	(1) PROHIBIT A BENEFICIARY FROM S ELECTING, OR LIMITING A 14
170	170	BENEFICIARY’S ABILITY TO SELECT , A PHARMACY OR PHARMA CIST OF THE 15
171	171	BENEFICIARY’S CHOICE IF THE PHARMACY OR PHARMACI ST HAS AGREED TO 16
172	172	PARTICIPATE AS A CONTRACTED PROV IDER FOR THE PHARMACY BENEFITS 17
173	173	MANAGER OR PURCHASER ; 18
174	174
175	175	(2) DENY A PHARMACY OR PH ARMACIST THE RIGHT T O PARTICIPATE 19
176	176	AS A CONTRACT PROVID ER UNDER A PARTICIPATING PHAR MACY CONTRACT IF THE 20
177	177	PHARMACY OR PHARMACI ST AGREES TO THE TERMS AND REQUIREMENTS FOR 21
178	178	PARTICIPATING IN THE PHARMACY BENEFITS MA NAGER’S OR PURCHASER ’S 22
179	179	NETWORK FOR THE GEOGRAPHICAL AREA, INCLUDING REQUIREMENTS FOR: 23
180	180
181	181	(I) PROVIDING PHARMACY SERVICES , INCLUDING DISPENSING 24
182	182	PRESCRIPTION DRUGS ; AND 25
183	183
184	184	(II) REIMBURSEMENT ; 26
185	185
186	186	(3) IMPOSE ON A BENEFICIA RY ANY COPAYMENT , FEE, OR CONDITION 27
187	187	THAT IS NOT EQUALLY IMPOSED ON ALL BENEF ICIARIES IN THE SAME BENEFIT 28
188	188	CATEGORY, CLASS, OR COPAYMENT LEVEL IF THE BENEFICIARY I S RECEIVING 29
189	189	PHARMAC Y SERVICES FROM A CONT RACT PROVIDER ; 30
190	190	HOUSE BILL 1008 5
191	191
192	192
193	193	(4) IMPOSE A MON ETARY ADVANTAGE OR P ENALTY THAT WOULD 1
194	194	AFFECT A BENEFICIARY ’S CHOICE OF CONTRACTED PROVID ERS, INCLUDING: 2
195	195
196	196	(I) CHARGING DIFFERENT COPAYMENT S FOR DIFFERENT 3
197	197	CONTRACTED PROVIDERS ; 4
198	198
199	199	(II) REDUCING REIMBURSEMENT FOR SE RVICES; OR 5
200	200
201	201	(III) PROMOTING ONE CONTRACT PROVIDE R OVER ANOTHER 6
202	202	CONTRACT PROVIDER ; 7
203	203
204	204	(5) REDUCE ALLOWABLE REIM BURSEMENT FOR PHARMA CY 8
205	205	SERVICES TO A BENEFI CIARY BECAUSE THE BE NEFICIARY SELECTS ONE CONTRACT 9
206	206	PROVIDER OVER ANOTHE R; 10
207	207
208	208	(6) REQUIRE A BENEFICIARY , AS A CONDITION OF PA YMENT OR 11
209	209	REIMBURSEMENT , TO PURCHASE PHARMACY SERVICES, INCLUDING PRESCRIPTI ON 12
210	210	DRUGS, EXCLUSIVELY THROUGH A MAIL–ORDER PHARMACY ; OR 13
211	211
212	212	(7) IMPOSE ON A BENEFICIA RY A COPAYMENT , AN AMOUNT OF 14
213	213	REIMBURSEMENT , A LIMITATION ON THE NUMBER OF DAYS OF A DRUG SUPPLY FOR 15
214	214	WHICH REIMBURSEMENT WIL L BE ALLOWED , OR ANY OTHER PAYMENT OR 16
215	215	CONDITION RELATING T O THE PURCHASE OF A PHARMACY SERVICE FRO M A 17
216	216	PHARMACY THAT IS MORE COSTLY OR MORE RESTRICTIVE TO A BENEFICIARY THA N 18
217	217	WOULD BE IMPOSED ON THE BENEFICIARY IF THE SAME PHARMACY SERVICE WERE 19
218	218	PURCHASED FROM A MAI L–ORDER PHARMACY OR AN Y OTHER PHARMACY THA T IS 20
219	219	WILLING TO PROVIDE T HE SAME SERVICES OR PRODUCTS FOR THE SAM E COST AND 21
220	220	COPAYMENT AS ANY MAI L–ORDER SERVICE . 22
221	221
222	222	(D) (1) IF A PHARMACY BENEFITS MA NAGER OR A PURCHASER 23
223	223	RESTRICTS PHARMACY P ARTICIPATION OF CONTRACTED PROVIDER S IN A 24
224	224	GEOGRAPHICAL COVERAG E AREA, THE PHARMACY BENEFITS MA NAGER OR 25
225	225	PURCHASER SHALL NOTIFY , IN WRITING, ALL PHARMACIES AND PHARMACISTS 26
226	226	WITHIN THE GEOGRAPHI CAL COVERAGE AREA OF THE PHARMACY BENEFITS 27
227	227	MANAGER’S OR PURCHASER ’S NETWORK , AND OFFER TO THE PHA RMACIES AND 28
228	228	PHARMACISTS THE OPPORTUNITY TO P ARTICIPATE IN THE NETWORK AT LEAST 60 29
229	229	DAYS BEFORE THE EFFECTIVE DATE O F THE RESTRICTIONS . 30
230	230
231	231	(2) ALL PHARMACISTS OR PHARMACIES IN THE GE OGRAPHICAL 31
232	232	COVERAGE ARE A OF THE NETWORK SHALL BE ELIGIBLE TO PARTICIPATE UNDER 32
233	233	IDENTICAL REIMBURSEM ENT TERMS FOR PROVID ING PHARMACY SERVICE S, 33
234	234	INCLUDING PRESCRIPTI ON DRUGS. 34
235	235	6 HOUSE BILL 1008
236	236
237	237
238	238	(3) THE PHARMACY BENEFITS MA NAGER OR PURCHASER SHALL, 1
239	239	THROUGH REASONABLE M EANS, ON A TIMELY BASIS AN D AT REGULAR INTERVALS , 2
240	240	INFORM ITS BENEFICIARIES OF THE NAMES AND LOCATIONS OF PHARMACIES AND 3
241	241	PHARMACISTS THAT ARE PARTICIPATI NG IN THE NETWORK AS CONTRACTED 4
242	242	PROVIDERS. 5
243	243
244	244	(4) CONTRACTED PROVIDERS MAY ANNOUNCE THEIR 6
245	245	PARTICIPATION TO THE IR CUSTOMERS THROUGH A MEANS ACCEPTABLE T O THE 7
246	246	CONTRACTED PROVIDER AND PHARMACY BENEFIT S MANAGER OR PURCHAS ER. 8
247	247
248	248	(E) THE COMMISSIONER MAY DISAPPROVE A PARTICIPATING CONTRACT 9
249	249	THAT DOES NOT COMPLY WITH THIS SECTION. 10
250	250
251	251	(F) A BENEFICIARY, PHARMACY, OR PHARMACIST INJURED BY A VIOLATI ON 11
252	252	OF THIS SECTION MAY MAINTAIN A CAUSE OF ACTION TO ENJOIN THE CONTINUANCE 12
253	253	OF THE VIOLATION. 13
254	254
255	255	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 14
256	256	October 1, 2022. 15