MD
Maryland Senate Bill SB823

Maryland 2022 Regular Session

Maryland Senate Bill SB823 Compare Versions

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1- LAWRENCE J. HOGAN, JR., Governor Ch. 308
21
3-– 1 –
4-Chapter 308
5-(Senate Bill 823)
62
7-AN ACT concerning
3+EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4+ [Brackets] indicate matter deleted from existing law.
5+ Underlining indicates amendments to bill.
6+ Strike out indicates matter stricken from the bill by amendment or deleted from the law by
7+amendment.
8+ *sb0823*
89
9-Pharmacy Services Administrative Organizations and Pharmacy Benefits
10-Managers – Contracts
10+SENATE BILL 823
11+J5 2lr2806
12+ CF HB 973
13+By: Senator Kramer
14+Introduced and read first time: February 7, 2022
15+Assigned to: Finance
16+Committee Report: Favorable with amendments
17+Senate action: Adopted
18+Read second time: March 7, 2022
1119
12-FOR the purpose of requiring pharmacy benefits managers or group purchasing
13-organizations, rather than pharmacy services administrative organizations, to
14-submit contracts between pharmacy services administrative organizations and
15-pharmacy benefits managers or group purchasing organizations to the Maryland
16-Insurance Administration; repealing the prohibition on pharmacy services
17-administrative organizations entering into agreements or contracts with pharmacy
18-benefits managers if the organization has not registered with the Maryland
19-Insurance Commissioner; requiring allowing pharmacy services administrative
20-organizations to provide access to, rather than copies of, certain documents to
21-independent pharmacies in an electronic or paper format; and generally relating to
22-pharmacy services administrative organizations and pharmacy benefits managers.
20+CHAPTER ______
2321
24-BY repealing and reenacting, with amendments,
25- Article – Insurance
26-Section 15–1628, 15–2004, 15–2010, and 15–2011
27- Annotated Code of Maryland
28- (2017 Replacement Volume and 2021 Supplement)
22+AN ACT concerning 1
2923
30- SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
31-That the Laws of Maryland read as follows:
24+Pharmacy Services Administrative Organizations and Pharmacy Benefits 2
25+Managers – Contracts 3
3226
33-Article – Insurance
27+FOR the purpose of requiring pharmacy benefits managers or group purchasing 4
28+organizations, rather than pharmacy services administrative organizations, to 5
29+submit contracts between pharmacy services administrative organizations and 6
30+pharmacy benefits managers or group purchasing organizations to the Maryland 7
31+Insurance Administration; repealing the prohibition on pharmacy services 8
32+administrative organizations entering into agreements or contracts with pharmacy 9
33+benefits managers if the organization has not registered with the Maryland 10
34+Insurance Commissioner; requiring allowing pharmacy services administrative 11
35+organizations to provide access to, rather than copies of, certain documents to 12
36+independent pharmacies in an electronic or paper format; and generally relating to 13
37+pharmacy services administrative organizations and pharmacy benefits managers. 14
3438
35-15–1628.
39+BY repealing and reenacting, with amendments, 15
40+ Article – Insurance 16
41+Section 15–1628, 15–2004, 15–2010, and 15–2011 17
42+ Annotated Code of Maryland 18
43+ (2017 Replacement Volume and 2021 Supplement) 19
3644
37- (a) (1) At the time of entering into a contract with a pharmacy or a pharmacist,
38-and at least 30 working days before any contract change, a pharmacy benefits manager
39-shall disclose to the pharmacy or pharmacist:
45+ SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 20
46+That the Laws of Maryland read as follows: 21
4047
41- (i) the applicable terms, conditions, and reimbursement rates;
48+Article – Insurance 22 2 SENATE BILL 823
4249
43- (ii) the process and procedures for verifying pharmacy benefits and
44-beneficiary eligibility;
4550
46- (iii) the dispute resolution and audit appeals process; and
4751
48- (iv) the process and procedures for verifying the prescription drugs
49-included on the formularies used by the pharmacy benefits manager. Ch. 308 2022 LAWS OF MARYLAND
52+15–1628. 1
5053
51-– 2 –
54+ (a) (1) At the time of entering into a contract with a pharmacy or a pharmacist, 2
55+and at least 30 working days before any contract change, a pharmacy benefits manager 3
56+shall disclose to the pharmacy or pharmacist: 4
5257
53- (2) (i) This paragraph does not apply to a requirement that a specialty
54-pharmacy obtain national certification to be considered a specialty pharmacy in a pharmacy
55-benefits manager’s or carrier’s network.
58+ (i) the applicable terms, conditions, and reimbursement rates; 5
5659
57- (ii) For purposes of credentialing a pharmacy or a pharmacist as a
58-condition for participating in a pharmacy benefits manager’s network for a carrier, the
59-pharmacy benefits manager may not:
60+ (ii) the process and procedures for verifying pharmacy benefits and 6
61+beneficiary eligibility; 7
6062
61- 1. require a pharmacy or pharmacist to renew credentialing
62-more frequently than once every 3 years; or
63+ (iii) the dispute resolution and audit appeals process; and 8
6364
64- 2. charge a pharmacy or pharmacist a fee for the initial
65-credentialing or renewing credentialing.
65+ (iv) the process and procedures for verifying the prescription drugs 9
66+included on the formularies used by the pharmacy benefits manager. 10
6667
67- (b) (1) Each contract form or an amendment to a contract form between a
68-pharmacy benefits manager and a pharmacy OR A PHARMACY SERVIC ES
69-ADMINISTRATIVE ORGAN IZATION, AS DEFINED IN § 15–2001 OF THIS TITLE, ACTING
70-ON BEHALF OF A PHARM ACY may not become effective unless at least 30 days before the
71-contract form or amendment to the contract form is to become effective, the pharmacy
72-benefits manager files an informational filing with the Commissioner in the manner
73-required by the Commissioner that includes a copy of the contract form or amendment to
74-the contract form.
68+ (2) (i) This paragraph does not apply to a requirement that a specialty 11
69+pharmacy obtain national certification to be considered a specialty pharmacy in a pharmacy 12
70+benefits manager’s or carrier’s network. 13
7571
76- (2) The Commissioner is not required to review the informational filing to
77-evaluate whether a contract form or amendment to a contract form is in violation of this
78-subtitle at the time the informational filing is made.
72+ (ii) For purposes of credentialing a pharmacy or a pharmacist as a 14
73+condition for participating in a pharmacy benefits manager’s network for a carrier, the 15
74+pharmacy benefits manager may not: 16
7975
80- (3) The Commissioner may review and disapprove a contract form or
81-amendment to a contract form at any time after the contract form or amendment to the
82-contract form has been submitted as part of an informational filing.
76+ 1. require a pharmacy or pharmacist to renew credentialing 17
77+more frequently than once every 3 years; or 18
8378
84-15–2004.
79+ 2. charge a pharmacy or pharmacist a fee for the initial 19
80+credentialing or renewing credentialing. 20
8581
86- A pharmacy services administrative organization that has not registered with the
87-Commissioner may not enter into an agreement or a contract with an independent
88-pharmacy [or a pharmacy benefits manager].
82+ (b) (1) Each contract form or an amendment to a contract form between a 21
83+pharmacy benefits manager and a pharmacy OR A PHARMACY SERVIC ES 22
84+ADMINISTRATIVE ORGAN IZATION, AS DEFINED IN § 15–2001 OF THIS TITLE, ACTING 23
85+ON BEHALF OF A PHARM ACY may not become effective unless at least 30 days before the 24
86+contract form or amendment to the contract form is to become effective, the pharmacy 25
87+benefits manager files an informational filing with the Commissioner in the manner 26
88+required by the Commissioner that includes a copy of the contract form or amendment to 27
89+the contract form. 28
8990
90-15–2010.
91+ (2) The Commissioner is not required to review the informational filing to 29
92+evaluate whether a contract form or amendment to a contract form is in violation of this 30
93+subtitle at the time the informational filing is made. 31
9194
92- (a) A pharmacy services administrative contract or an amendment to a pharmacy
93-services administrative contract [or a contract or an amendment to a contract between a
94-pharmacy services administrative organization, on behalf of an independent pharmacy, and
95-a pharmacy benefits manager or group purchasing organization] may not become effective
96-unless:
97- LAWRENCE J. HOGAN, JR., Governor Ch. 308
95+ (3) The Commissioner may review and disapprove a contract form or 32
96+amendment to a contract form at any time after the contract form or amendment to the 33
97+contract form has been submitted as part of an informational filing. 34 SENATE BILL 823 3
9898
99-– 3 –
100- (1) at least 60 days before the contract or amendment is to become effective,
101-the pharmacy services administrative organization files the contract or, if required,
102-amendment with the Commissioner in the form required by the Commissioner; and
10399
104- (2) the Commissioner does not disapprove the filing within 60 days after
105-the contract or amendment is filed.
106100
107- (b) Notice from the Commissioner that a filed contract or amendment to a
108-contract may be used in the State constitutes a waiver of any unexpired part of the filing
109-period.
101+15–2004. 1
110102
111- (c) The Commissioner shall adopt regulations to:
103+ A pharmacy services administrative organization that has not registered with the 2
104+Commissioner may not enter into an agreement or a contract with an independent 3
105+pharmacy [or a pharmacy benefits manager]. 4
112106
113- (1) establish the circumstances under which the Commissioner may
114-disapprove a contract; and
107+15–2010. 5
115108
116- (2) specify the types of amendments to a contract required to be filed under
117-subsection (a) of this section.
109+ (a) A pharmacy services administrative contract or an amendment to a pharmacy 6
110+services administrative contract [or a contract or an amendment to a contract between a 7
111+pharmacy services administrative organization, on behalf of an independent pharmacy, and 8
112+a pharmacy benefits manager or group purchasing organization] may not become effective 9
113+unless: 10
118114
119-15–2011.
115+ (1) at least 60 days before the contract or amendment is to become effective, 11
116+the pharmacy services administrative organization files the contract or, if required, 12
117+amendment with the Commissioner in the form required by the Commissioner; and 13
120118
121- (a) A pharmacy services administrative contract shall include a provision that
122-requires the pharmacy services administrative organization to provide to the independent
123-pharmacy [a AN ELECTRONIC OR PAP ER copy of] ACCESS TO any contracts,
124-amendments, payment schedules, or reimbursement rates within 5 working days after the
125-execution of a contract, or an amendment to a contract, signed on behalf of the independent
126-pharmacy by the pharmacy services administrative organization.
119+ (2) the Commissioner does not disapprove the filing within 60 days after 14
120+the contract or amendment is filed. 15
127121
128- (b) A pharmacy services administrative contract may prohibit an independent
129-pharmacy from disclosing the documents provided to the independent pharmacy under
130-subsection (a) of this section to any competitor of the pharmacy services administrative
131-organization.
122+ (b) Notice from the Commissioner that a filed contract or amendment to a 16
123+contract may be used in the State constitutes a waiver of any unexpired part of the filing 17
124+period. 18
132125
133- SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
134-October 1, 2022.
126+ (c) The Commissioner shall adopt regulations to: 19
135127
136-Approved by the Governor, May 12, 2022.
128+ (1) establish the circumstances under which the Commissioner may 20
129+disapprove a contract; and 21
130+
131+ (2) specify the types of amendments to a contract required to be filed under 22
132+subsection (a) of this section. 23
133+
134+15–2011. 24
135+
136+ (a) A pharmacy services administrative contract shall include a provision that 25
137+requires the pharmacy services administrative organization to provide to the independent 26
138+pharmacy [a AN ELECTRONIC OR PAP ER copy of] ACCESS TO any contracts, 27
139+amendments, payment schedules, or reimbursement rates within 5 working days after the 28
140+execution of a contract, or an amendment to a contract, signed on behalf of the independent 29
141+pharmacy by the pharmacy services administrative organization. 30
142+
143+ (b) A pharmacy services administrative contract may prohibit an independent 31
144+pharmacy from disclosing the documents provided to the independent pharmacy under 32
145+subsection (a) of this section to any competitor of the pharmacy services administrative 33
146+organization. 34 4 SENATE BILL 823
147+
148+
149+
150+ SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 1
151+October 1, 2022. 2
152+
153+
154+
155+
156+
157+Approved:
158+________________________________________________________________________________
159+ Governor.
160+________________________________________________________________________________
161+ President of the Senate.
162+________________________________________________________________________________
163+ Speaker of the House of Delegates.