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