Maryland House Bill HB1009

Maryland 2022 Regular Session

• Introduced: 2/10/22
• Refer: 2/10/22

Caption

Health Insurance - Pharmacy Benefits Managers - Reimbursement and Cost Sharing

Impact

The enactment of HB1009 is expected to significantly alter the landscape of health insurance and pharmacy practices across Maryland. By establishing clearer guidelines on reimbursements, the bill mandates that cost-sharing for consumers is calculated at the point of sale based on a defined price. It also requires that any rebates received regarding the dispensing of drugs directly benefit the purchasers by reducing their premiums, thereby promoting transparency and fairness in drug pricing.

Summary

House Bill 1009 is designed to reform the operations of pharmacy benefit managers (PBMs) within the state of Maryland, focusing primarily on reimbursement strategies and cost-sharing practices related to prescription drugs. The bill modifies existing regulations to ensure that PBMs cannot reimburse pharmacists or pharmacies at lower rates than they would reimburse themselves or their affiliates. This aims to create a fairer financial environment for pharmacies, ensuring that they receive equitable compensation for the services they provide.

Contention

During discussions surrounding the bill, prominent points of contention revolved around how these changes might affect the relationship between PBMs, pharmacies, and consumers. Proponents argue that the legislation will help reduce costs and improve access to necessary medications for patients, ensuring that they do not face unexpected charges at the pharmacy counter. Conversely, some stakeholders expressed concerns that these measures could lead to unintended consequences, such as reduced access to certain drugs or increased operational burdens on smaller pharmacies, potentially impacting rural and underserved areas more severely.