LAWRENCE J. HOGAN, JR., Governor Ch. 308
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Chapter 308
(Senate Bill 823)
AN ACT concerning
Pharmacy Services Administrative Organizations and Pharmacy Benefits
Managers – Contracts
FOR the purpose of requiring pharmacy benefits managers or group purchasing
organizations, rather than pharmacy services administrative organizations, to
submit contracts between pharmacy services administrative organizations and
pharmacy benefits managers or group purchasing organizations to the Maryland
Insurance Administration; repealing the prohibition on pharmacy services
administrative organizations entering into agreements or contracts with pharmacy
benefits managers if the organization has not registered with the Maryland
Insurance Commissioner; requiring allowing pharmacy services administrative
organizations to provide access to, rather than copies of, certain documents to
independent pharmacies in an electronic or paper format; and generally relating to
pharmacy services administrative organizations and pharmacy benefits managers.
BY repealing and reenacting, with amendments,
Article – Insurance
Section 15–1628, 15–2004, 15–2010, and 15–2011
Annotated Code of Maryland
(2017 Replacement Volume and 2021 Supplement)
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
That the Laws of Maryland read as follows:
Article – Insurance
15–1628.
(a) (1) At the time of entering into a contract with a pharmacy or a pharmacist,
and at least 30 working days before any contract change, a pharmacy benefits manager
shall disclose to the pharmacy or pharmacist:
(i) the applicable terms, conditions, and reimbursement rates;
(ii) the process and procedures for verifying pharmacy benefits and
beneficiary eligibility;
(iii) the dispute resolution and audit appeals process; and
(iv) the process and procedures for verifying the prescription drugs
included on the formularies used by the pharmacy benefits manager. Ch. 308 2022 LAWS OF MARYLAND
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(2) (i) This paragraph does not apply to a requirement that a specialty
pharmacy obtain national certification to be considered a specialty pharmacy in a pharmacy
benefits manager’s or carrier’s network.
(ii) For purposes of credentialing a pharmacy or a pharmacist as a
condition for participating in a pharmacy benefits manager’s network for a carrier, the
pharmacy benefits manager may not:
1. require a pharmacy or pharmacist to renew credentialing
more frequently than once every 3 years; or
2. charge a pharmacy or pharmacist a fee for the initial
credentialing or renewing credentialing.
(b) (1) Each contract form or an amendment to a contract form between a
pharmacy benefits manager and a pharmacy OR A PHARMACY SERVIC ES
ADMINISTRATIVE ORGAN IZATION, AS DEFINED IN § 15–2001 OF THIS TITLE, ACTING
ON BEHALF OF A PHARM ACY may not become effective unless at least 30 days before the
contract form or amendment to the contract form is to become effective, the pharmacy
benefits manager files an informational filing with the Commissioner in the manner
required by the Commissioner that includes a copy of the contract form or amendment to
the contract form.
(2) The Commissioner is not required to review the informational filing to
evaluate whether a contract form or amendment to a contract form is in violation of this
subtitle at the time the informational filing is made.
(3) The Commissioner may review and disapprove a contract form or
amendment to a contract form at any time after the contract form or amendment to the
contract form has been submitted as part of an informational filing.
15–2004.
A pharmacy services administrative organization that has not registered with the
Commissioner may not enter into an agreement or a contract with an independent
pharmacy [or a pharmacy benefits manager].
15–2010.
(a) A pharmacy services administrative contract or an amendment to a pharmacy
services administrative contract [or a contract or an amendment to a contract between a
pharmacy services administrative organization, on behalf of an independent pharmacy, and
a pharmacy benefits manager or group purchasing organization] may not become effective
unless:
LAWRENCE J. HOGAN, JR., Governor Ch. 308
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(1) at least 60 days before the contract or amendment is to become effective,
the pharmacy services administrative organization files the contract or, if required,
amendment with the Commissioner in the form required by the Commissioner; and
(2) the Commissioner does not disapprove the filing within 60 days after
the contract or amendment is filed.
(b) Notice from the Commissioner that a filed contract or amendment to a
contract may be used in the State constitutes a waiver of any unexpired part of the filing
period.
(c) The Commissioner shall adopt regulations to:
(1) establish the circumstances under which the Commissioner may
disapprove a contract; and
(2) specify the types of amendments to a contract required to be filed under
subsection (a) of this section.
15–2011.
(a) A pharmacy services administrative contract shall include a provision that
requires the pharmacy services administrative organization to provide to the independent
pharmacy [a AN ELECTRONIC OR PAP ER copy of] ACCESS TO any contracts,
amendments, payment schedules, or reimbursement rates within 5 working days after the
execution of a contract, or an amendment to a contract, signed on behalf of the independent
pharmacy by the pharmacy services administrative organization.
(b) A pharmacy services administrative contract may prohibit an independent
pharmacy from disclosing the documents provided to the independent pharmacy under
subsection (a) of this section to any competitor of the pharmacy services administrative
organization.
SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect
October 1, 2022.
Approved by the Governor, May 12, 2022.