EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb1004*
SENATE BILL 1004
J5 2lr3301
By: Senator Eckardt
Introduced and read first time: February 25, 2022
Assigned to: Rules
A BILL ENTITLED
AN ACT concerning 1
Health Insurance – Pharmacy Benefits Managers – Reimbursement Amounts 2
FOR the purpose of altering how a pharmacy benefits manager may determine 3
reimbursement for a pharmacy or pharmacist; authorizing the Maryland Insurance 4
Commissioner to require a pharmacy benefits manager to pay a certain fee in 5
addition to the required reimbursement amount to a pharmacy or a pharmacist and 6
to adopt regulations that include a process for reviewing and recalculating the 7
reimbursement amount; and generally relating to pharmacy benefits managers and 8
reimbursement for prescription drugs and pharmacy services. 9
BY repealing and reenacting, with amendments, 10
Article – Insurance 11
Section 15–1628.3 12
Annotated Code of Maryland 13
(2017 Replacement Volume and 2021 Supplement) 14
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 15
That the Laws of Maryland read as follows: 16
Article – Insurance 17
15–1628.3. 18
(a) A pharmacy benefits manager or a carrier may not directly or indirectly 19
charge a contracted pharmacy, or hold a contracted pharmacy responsible for, a fee or 20
performance–based reimbursement related to the adjudication of a claim or an incentive 21
program. 22
(b) A pharmacy benefits manager or carrier may not make or allow any reduction 23
in payment for pharmacy services by a pharmacy benefits manager or carrier or directly or 24
indirectly reduce a payment for a pharmacy service under a reconciliation process to an 25 2 SENATE BILL 1004
effective rate of reimbursement, including generic effective rates, brand effective rates, 1
direct and indirect remuneration fees, or any other reduction or aggregate reduction of 2
payments. 3
(C) (1) EXCEPT AS PROVIDED IN PARAGRAPH (2) OF THIS SUBSECTION , A 4
PHARMACY BENEFITS MANAG ER MAY NOT REIMBURSE A PHARMACY OR 5
PHARMACIST FOR A PRE SCRIPTION DRUG OR PHARMACY SERVICE IN AN AMOUNT 6
LESS THAN THE NATIONAL AVERAGE DRUG ACQUISI TION COST FOR THE 7
PRESCRIPTION DRUG OR PHARMACY SERVICE AT THE TIME THE DRUG IS 8
ADMINISTERED OR DISP ENSED PLUS 10% OF THAT COST. 9
(2) IF THE NATIONAL AVERAGE DRUG ACQUISI TION COST IS NOT 10
AVAILABLE AT THE TIM E A DRUG IS ADMINIST ERED OR DISPENSED , A PHARMACY 11
BENEFITS MANAGER MAY NOT REIMBURSE IN AN AMOUNT THAT IS LESS THAN THE 12
WHOLESALE ACQUISITIO N COST OF THE DRUG , AS DEFINED IN 42 U.S.C. § 13
1395W–3A(C)(6)(B). 14
(3) THE COMMISSIONER MAY: 15
(I) REQUIRE THAT A PHARM ACY BENEFITS MANAGER PAY A 16
FEE, TO BE DETERMINED BY THE COMMISSIONER , IN ADDITION TO THE 17
REIMBURSEMENT AMOUNT REQUIRED UNDER THIS SUBSECTION ; AND 18
(II) ADOPT REGULATIONS TO CARRY OUT THIS SUBSE CTION 19
THAT INCLUDE A PROCE SS FOR PERIODICALLY REVIEWING AND RECALC ULATING 20
THE REIMBURSEMENT AM OUNT UNDER THIS SUBS ECTION. 21
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 22
October 1, 2022. 23