Maryland 2022 Regular Session

Maryland Senate Bill SB1004 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	sb1004
6	6
7	7	SENATE BILL 1004
8	8	J5 2lr3301
9	9
10	10	By: Senator Eckardt
11	11	Introduced and read first time: February 25, 2022
12	12	Assigned to: Rules
13	13
14	14	A BILL ENTITLED
15	15
16	16	AN ACT concerning 1
17	17
18	18	Health Insurance – Pharmacy Benefits Managers – Reimbursement Amounts 2
19	19
20	20	FOR the purpose of altering how a pharmacy benefits manager may determine 3
21	21	reimbursement for a pharmacy or pharmacist; authorizing the Maryland Insurance 4
22	22	Commissioner to require a pharmacy benefits manager to pay a certain fee in 5
23	23	addition to the required reimbursement amount to a pharmacy or a pharmacist and 6
24	24	to adopt regulations that include a process for reviewing and recalculating the 7
25	25	reimbursement amount; and generally relating to pharmacy benefits managers and 8
26	26	reimbursement for prescription drugs and pharmacy services. 9
27	27
28	28	BY repealing and reenacting, with amendments, 10
29	29	Article – Insurance 11
30	30	Section 15–1628.3 12
31	31	Annotated Code of Maryland 13
32	32	(2017 Replacement Volume and 2021 Supplement) 14
33	33
34	34	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 15
35	35	That the Laws of Maryland read as follows: 16
36	36
37	37	Article – Insurance 17
38	38
39	39	15–1628.3. 18
40	40
41	41	(a) A pharmacy benefits manager or a carrier may not directly or indirectly 19
42	42	charge a contracted pharmacy, or hold a contracted pharmacy responsible for, a fee or 20
43	43	performance–based reimbursement related to the adjudication of a claim or an incentive 21
44	44	program. 22
45	45
46	46	(b) A pharmacy benefits manager or carrier may not make or allow any reduction 23
47	47	in payment for pharmacy services by a pharmacy benefits manager or carrier or directly or 24
48	48	indirectly reduce a payment for a pharmacy service under a reconciliation process to an 25 2 SENATE BILL 1004
49	49
50	50
51	51	effective rate of reimbursement, including generic effective rates, brand effective rates, 1
52	52	direct and indirect remuneration fees, or any other reduction or aggregate reduction of 2
53	53	payments. 3
54	54
55	55	(C) (1) EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS SUBSECTION , A 4
56	56	PHARMACY BENEFITS MANAG ER MAY NOT REIMBURSE A PHARMACY OR 5
57	57	PHARMACIST FOR A PRE SCRIPTION DRUG OR PHARMACY SERVICE IN AN AMOUNT 6
58	58	LESS THAN THE NATIONAL AVERAGE DRUG ACQUISI TION COST FOR THE 7
59	59	PRESCRIPTION DRUG OR PHARMACY SERVICE AT THE TIME THE DRUG IS 8
60	60	ADMINISTERED OR DISP ENSED PLUS 10% OF THAT COST. 9
61	61
62	62	(2) IF THE NATIONAL AVERAGE DRUG ACQUISI TION COST IS NOT 10
63	63	AVAILABLE AT THE TIM E A DRUG IS ADMINIST ERED OR DISPENSED , A PHARMACY 11
64	64	BENEFITS MANAGER MAY NOT REIMBURSE IN AN AMOUNT THAT IS LESS THAN THE 12
65	65	WHOLESALE ACQUISITIO N COST OF THE DRUG , AS DEFINED IN 42 U.S.C. § 13
66	66	1395W–3A(C)(6)(B). 14
67	67
68	68	(3) THE COMMISSIONER MAY: 15
69	69
70	70	(I) REQUIRE THAT A PHARM ACY BENEFITS MANAGER PAY A 16
71	71	FEE, TO BE DETERMINED BY THE COMMISSIONER , IN ADDITION TO THE 17
72	72	REIMBURSEMENT AMOUNT REQUIRED UNDER THIS SUBSECTION ; AND 18
73	73
74	74	(II) ADOPT REGULATIONS TO CARRY OUT THIS SUBSE CTION 19
75	75	THAT INCLUDE A PROCE SS FOR PERIODICALLY REVIEWING AND RECALC ULATING 20
76	76	THE REIMBURSEMENT AM OUNT UNDER THIS SUBS ECTION. 21
77	77
78	78	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 22
79	79	October 1, 2022. 23