Maryland 2022 Regular Session

Maryland Senate Bill SB621 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 MATTER ADDE D TO EXISTING LAW .
4	4	[Brackets] indicate matter deleted from existing law.
5	5	sb0621
6	6
7	7	SENATE BILL 621
8	8	J5, J4 2lr2810
9	9	CF HB 675
10	10	By: Senators Corderman, Edwards, Hershey, Salling, Simonaire, Watson, and
11	11	West
12	12	Introduced and read first time: February 2, 2022
13	13	Assigned to: Finance
14	14
15	15	A BILL ENTITLED
16	16
17	17	AN ACT concerning 1
18	18
19	19	Health Insurance – Changes to Coverage, Benefits, and Drug Formularies – 2
20	20	Timing 3
21	21
22	22	FOR the purpose of prohibiting certain insurers, nonprofit health service plans, and health 4
23	23	maintenance organizations from making changes to coverage, benefits, or drug 5
24	24	formularies under a health insurance policy or contract during the term of the health 6
25	25	insurance policy or contract; authorizing certain insurers, nonprofit health service 7
26	26	plans, and health maintenance organizations to make certain changes to coverage, 8
27	27	benefits, and drug formularies on renewal of a health insurance policy or contract; 9
28	28	and generally relating to health insurance and changes to coverage, benefits, and 10
29	29	drug formularies. 11
30	30
31	31	BY adding to 12
32	32	Article – Insurance 13
33	33	Section 15–146 14
34	34	Annotated Code of Maryland 15
35	35	(2017 Replacement Volume and 2021 Supplement) 16
36	36
37	37	BY repealing and reenacting, with amendments, 17
38	38	Article – Insurance 18
39	39	Section 15–831 19
40	40	Annotated Code of Maryland 20
41	41	(2017 Replacement Volume and 2021 Supplement) 21
42	42
43	43	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 22
44	44	That the Laws of Maryland read as follows: 23
45	45
46	46	Article – Insurance 24
47	47	2 SENATE BILL 621
48	48
49	49
50	50	15–146. 1
51	51
52	52	(A) THIS SECTION APPLIES TO: 2
53	53
54	54	(1) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 3
55	55	PROVIDE HOSPITAL , MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS 4
56	56	ON AN EXPENSE –INCURRED BASIS UNDER HEALTH INSURANCE POL ICIES THAT ARE 5
57	57	ISSUED OR DELIVERED IN THE STATE; 6
58	58
59	59	(2) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 7
60	60	HOSPITAL, MEDICAL, OR SURGICAL BENEFITS TO INDIVIDUALS OR GR OUPS UNDER 8
61	61	CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE; AND 9
62	62
63	63	(3) INSURERS, NONPROFIT HEALTH SER VICE PLANS, AND HEALTH 10
64	64	MAINTENANCE ORGANIZA TIONS THAT PROVIDE C OVERAGE FOR PRESCRIP TION 11
65	65	DRUGS THROUGH A PHAR MACY BENEFITS MANAGE R. 12
66	66
67	67	(B) NOTWITHSTANDING ANY O THER PROVISION OF LA W, AN ENTITY 13
68	68	SUBJECT TO THIS SECT ION: 14
69	69
70	70	(1) MAY NOT CHANGE THE C OVERAGE OF SERVICES OR BENEFITS 15
71	71	PROVIDED UNDER A HEA LTH INSURANCE POLICY OR CONTRACT DURING T HE TERM 16
72	72	OF THE POLICY OR CONTRACT; AND 17
73	73
74	74	(2) MAY CHANGE THE COVER AGE OF SERVICES OR B ENEFITS 18
75	75	PROVIDED UNDER A HEA LTH INSURANCE POLICY OR CONTRACT ON RENEW AL OF 19
76	76	THE POLICY OR CONTRA CT. 20
77	77
78	78	15–831. 21
79	79
80	80	(a) (1) In this section the following words have the meanings indicated. 22
81	81
82	82	(2) “Authorized prescriber” has the meaning stated in § 12–101 of the 23
83	83	Health Occupations Article. 24
84	84
85	85	(3) “Formulary” means a list of prescription drugs or devices that are 25
86	86	covered by an entity subject to this section. 26
87	87
88	88	(4) (i) “Member” means an individual entitled to health care benefits 27
89	89	for prescription drugs or devices under a policy issued or delivered in the State by an entity 28
90	90	subject to this section. 29
91	91
92	92	(ii) “Member” includes a subscriber. 30
93	93
94	94	(b) (1) This section applies to: 31 SENATE BILL 621 3
95	95
96	96
97	97
98	98	(i) insurers and nonprofit health service plans that provide coverage 1
99	99	for prescription drugs and devices under individual, group, or blanket health insurance 2
100	100	policies or contracts that are issued or delivered in the State; and 3
101	101
102	102	(ii) health maintenance organizations that provide coverage for 4
103	103	prescription drugs and devices under individual or group contracts that are issued or 5
104	104	delivered in the State. 6
105	105
106	106	(2) An insurer, nonprofit health service plan, or health maintenance 7
107	107	organization that provides coverage for prescription drugs and devices through a pharmacy 8
108	108	benefits manager is subject to the requirements of this section. 9
109	109
110	110	(3) This section does not apply to a managed care organization as defined 10
111	111	in § 15–101 of the Health – General Article. 11
112	112
113	113	(c) Each entity subject to this section that limits its coverage of prescription drugs 12
114	114	or devices to those in a formulary shall establish and implement a procedure by which a 13
115	115	member may: 14
116	116
117	117	(1) receive a prescription drug or device that is not in the entity’s formulary 15
118	118	or has been removed from the entity’s formulary in accordance with this section; or 16
119	119
120	120	(2) continue the same cost sharing requirements if the entity has moved 17
121	121	the prescription drug or device to a higher deductible, copayment, or coinsurance tier. 18
122	122
123	123	(d) The procedure shall provide for coverage for a prescription drug or device in 19
124	124	accordance with subsection (c) of this section if, in the judgment of the authorized 20
125	125	prescriber: 21
126	126
127	127	(1) there is no equivalent prescription drug or device in the entity’s 22
128	128	formulary in a lower tier; 23
129	129
130	130	(2) an equivalent prescription drug or device in the entity’s formulary in a 24
131	131	lower tier: 25
132	132
133	133	(i) has been ineffective in treating the disease or condition of the 26
134	134	member; or 27
135	135
136	136	(ii) has caused or is likely to cause an adverse reaction or other harm 28
137	137	to the member; or 29
138	138
139	139	(3) for a contraceptive prescription drug or device, the prescription drug or 30
140	140	device that is not on the formulary is medically necessary for the member to adhere to the 31
141	141	appropriate use of the prescription drug or device. 32
142	142
143	143	(e) A decision by an entity subject to this section not to provide access to or 33 4 SENATE BILL 621
144	144
145	145
146	146	coverage of a prescription drug or device in accordance with this section constitutes an 1
147	147	adverse decision as defined under Subtitle 10A of this title if the decision is based on a 2
148	148	finding that the proposed drug or device is not medically necessary, appropriate, or 3
149	149	efficient. 4
150	150
151	151	(f) (1) AN ENTITY SUBJECT TO THIS SECTION: 5
152	152
153	153	(I) MAY NOT REMOVE A DRU G FROM ITS FORMULARY OR MOVE 6
154	154	A PRESCRIPTION DRUG OR DEVICE TO A BENEF IT TIER THAT REQUIRE S A MEMBER 7
155	155	TO PAY A HIGHER DEDUCTIBLE , COPAYMENT , OR COINSURANCE AMOUN T FOR THE 8
156	156	PRESCRIPTION DRUG OR DEVICE DURING THE TE RM OF A HEALTH INSUR ANCE 9
157	157	POLICY OR CONTRACT ; AND 10
158	158
159	159	(II) MAY REMOVE A DRUG FR OM ITS FORMULARY OR MOVE A 11
160	160	PRESCRIPTION DRUG OR DEVICE TO A BENEFIT TIER THAT REQUIRES A MEMBER TO 12
161	161	PAY A HIGHER DEDUCTI BLE, COPAYMENT , OR COINSURANCE AMOUN T FOR THE 13
162	162	PRESCRIPTION DRUG OR DEVICE ON RENEWAL OF A HEALTH INSURANCE P OLICY OR 14
163	163	CONTRACT. 15
164	164
165	165	(2) [An] ON RENEWAL OF A HEALT H INSURANCE POLICY O R 16
166	166	CONTRACT, AN entity subject to this section that removes a drug from its formulary or 17
167	167	moves a prescription drug or device to a benefit tier that requires a member to pay a higher 18
168	168	deductible, copayment, or coinsurance amount for the prescription drug or device shall 19
169	169	provide a member who is currently on the prescription drug or device and the member’s 20
170	170	health care provider with: 21
171	171
172	172	[(1)] (I) notice of the change at least 30 days before the change is 22
173	173	implemented; and 23
174	174
175	175	[(2)] (II) in the notice required under item [(1)] (I) of this [subsection] 24
176	176	PARAGRAPH , the process for requesting an exemption through the procedure adopted in 25
177	177	accordance with this section. 26
178	178
179	179	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 27
180	180	policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 28
181	181	after January 1, 2023. 29
182	182
183	183	SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 30
184	184	January 1, 2023. 31
185	185