EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*sb0823*
SENATE BILL 823
J5 2lr2806
CF HB 973
By: Senator Kramer
Introduced and read first time: February 7, 2022
Assigned to: Finance
A BILL ENTITLED
AN ACT concerning 1
Pharmacy Services Administrative Organizations and Pharmacy Benefits 2
Managers – Contracts 3
FOR the purpose of requiring pharmacy benefits managers or group purchasing 4
organizations, rather than pharmacy services administrative organizations, to 5
submit contracts between pharmacy services administrative organizations and 6
pharmacy benefits managers or group purchasing organizations to the Maryland 7
Insurance Administration; repealing the prohibition on pharmacy services 8
administrative organizations entering into agreements or contracts with pharmacy 9
benefits managers if the organization has not registered with the Maryland 10
Insurance Commissioner; requiring pharmacy services administrative organizations 11
to provide access to, rather than copies of, certain documents to independent 12
pharmacies; and generally relating to pharmacy services administrative 13
organizations and pharmacy benefits managers. 14
BY repealing and reenacting, with amendments, 15
Article – Insurance 16
Section 15–1628, 15–2004, 15–2010, and 15–2011 17
Annotated Code of Maryland 18
(2017 Replacement Volume and 2021 Supplement) 19
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 20
That the Laws of Maryland read as follows: 21
Article – Insurance 22
15–1628. 23
(a) (1) At the time of entering into a contract with a pharmacy or a pharmacist, 24
and at least 30 working days before any contract change, a pharmacy benefits manager 25 2 SENATE BILL 823
shall disclose to the pharmacy or pharmacist: 1
(i) the applicable terms, conditions, and reimbursement rates; 2
(ii) the process and procedures for verifying pharmacy benefits and 3
beneficiary eligibility; 4
(iii) the dispute resolution and audit appeals process; and 5
(iv) the process and procedures for verifying the prescription drugs 6
included on the formularies used by the pharmacy benefits manager. 7
(2) (i) This paragraph does not apply to a requirement that a specialty 8
pharmacy obtain national certification to be considered a specialty pharmacy in a pharmacy 9
benefits manager’s or carrier’s network. 10
(ii) For purposes of credentialing a pharmacy or a pharmacist as a 11
condition for participating in a pharmacy benefits manager’s network for a carrier, the 12
pharmacy benefits manager may not: 13
1. require a pharmacy or pharmacist to renew credentialing 14
more frequently than once every 3 years; or 15
2. charge a pharmacy or pharmacist a fee for the initial 16
credentialing or renewing credentialing. 17
(b) (1) Each contract form or an amendment to a contract form between a 18
pharmacy benefits manager and a pharmacy OR A PHARMACY SERVIC ES 19
ADMINISTRATIVE ORGAN IZATION, AS DEFINED IN § 15–2001 OF THIS TITLE, ACTING 20
ON BEHALF OF A PHARM ACY may not become effective unless at least 30 days before the 21
contract form or amendment to the contract form is to become effective, the pharmacy 22
benefits manager files an informational filing with the Commissioner in the manner 23
required by the Commissioner that includes a copy of the contract form or amendment to 24
the contract form. 25
(2) The Commissioner is not required to review the informational filing to 26
evaluate whether a contract form or amendment to a contract form is in violation of this 27
subtitle at the time the informational filing is made. 28
(3) The Commissioner may review and disapprove a contract form or 29
amendment to a contract form at any time after the contract form or amendment to the 30
contract form has been submitted as part of an informational filing. 31
15–2004. 32
A pharmacy services administrative organization that has not registered with the 33
Commissioner may not enter into an agreement or a contract with an independent 34 SENATE BILL 823 3
pharmacy [or a pharmacy benefits manager]. 1
15–2010. 2
(a) A pharmacy services administrative contract or an amendment to a pharmacy 3
services administrative contract [or a contract or an amendment to a contract between a 4
pharmacy services administrative organization, on behalf of an independent pharmacy, and 5
a pharmacy benefits manager or group purchasing organization] may not become effective 6
unless: 7
(1) at least 60 days before the contract or amendment is to become effective, 8
the pharmacy services administrative organization files the contract or, if required, 9
amendment with the Commissioner in the form required by the Commissioner; and 10
(2) the Commissioner does not disapprove the filing within 60 days after 11
the contract or amendment is filed. 12
(b) Notice from the Commissioner that a filed contract or amendment to a 13
contract may be used in the State constitutes a waiver of any unexpired part of the filing 14
period. 15
(c) The Commissioner shall adopt regulations to: 16
(1) establish the circumstances under which the Commissioner may 17
disapprove a contract; and 18
(2) specify the types of amendments to a contract required to be filed under 19
subsection (a) of this section. 20
15–2011. 21
(a) A pharmacy services administrative contract shall include a provision that 22
requires the pharmacy services administrative organization to provide to the independent 23
pharmacy [a copy of] ACCESS TO any contracts, amendments, payment schedules, or 24
reimbursement rates within 5 working days after the execution of a contract, or an 25
amendment to a contract, signed on behalf of the independent pharmacy by the pharmacy 26
services administrative organization. 27
(b) A pharmacy services administrative contract may prohibit an independent 28
pharmacy from disclosing the documents provided to the independent pharmacy under 29
subsection (a) of this section to any competitor of the pharmacy services administrative 30
organization. 31
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 32
October 1, 2022. 33