Maryland 2023 Regular Session

Maryland House Bill HB382 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	WES MOORE, Governor Ch. 217
2	1
3		-	– 1 –
4		-	Chapter 217
5		-	(House Bill 382)
6	2
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	+	hb0382
8	9
9		-	Pharmacy Benefits Administration – Maryland Medical Assistance Program and
10		-	Pharmacy Benefits Managers
11		-	Maryland Department of Health and Prescription Drug Affordability Board –
12		-	Managed Care Organizations and Prescription Drug Claims – Study
	10	+	HOUSE BILL 382
	11	+	J5 EMERGENCY BILL 3lr0477
	12	+	CF SB 895
	13	+	By: Delegate Kipke Delegates Kipke, Alston, Bagnall, Bhandari, Chisholm,
	14	+	Cullison, Guzzone, Hill, Hutchinson, S. Johnson, Kaiser, Kerr, R. Lewis,
	15	+	Lopez, Martinez, M. Morgan, Pena–Melnyk, Reilly, Rosenberg, Szeliga,
	16	+	Taveras, White, and Woods
	17	+	Introduced and read first time: January 26, 2023
	18	+	Assigned to: Health and Government Operations
	19	+	Committee Report: Favorable with amendments
	20	+	House action: Adopted
	21	+	Read second time: March 5, 2023
13	22
14		-	FOR the purpose of altering the reimbursement levels for drug products that the Maryland
15		-	Medical Assistance Program is required to establish and that pharmacy benefits
16		-	managers that contract with a pharmacy on behalf of a managed care organization
17		-	are required to reimburse the pharmacy; altering the definition of “purchaser” for
18		-	purposes of certain provisions of law regulating pharmacy benefits managers to
19		-	include certain insurers, nonprofit health services plans, and health maintenance
20		-	organizations requiring the Maryland Department of Health and the Prescription
21		-	Drug Affordability Board jointly to study certain information regarding the payment
22		-	of prescription drug claims under the Maryland Medical Assistance Program during
23		-	certain calendar years and how to address certain inconsistencies; and generally
24		-	relating to pharmacy benefits administration managed care organizations and the
25		-	payment of prescription drug claims.
	23	+	CHAPTER ______
26	24
27		-	BY repealing and reenacting, with amendments,
28		-	Article – Health – General
29		-	Section 15–118(b)
30		-	Annotated Code of Maryland
31		-	(2019 Replacement Volume and 2022 Supplement)
	25	+	AN ACT concerning 1
32	26
33		-	BY adding to
34		-	Article – Health – General
35		-	Section 15–118(f)
36		-	Annotated Code of Maryland
37		-	(2019 Replacement Volume and 2022 Supplement)
	27	+	Pharmacy Benefits Administration – Maryland Medical Assistance Program and 2
	28	+	Pharmacy Benefits Managers 3
	29	+	Maryland Department of Health and Prescription Drug Affordability Board – 4
	30	+	Managed Care Organizations and Prescription Drug Claims – Study 5
38	31
39		-	BY repealing and reenacting, with amendments,
40		-	Article – Insurance
41		-	Section 15–1601(s)
42		-	Annotated Code of Maryland
43		-	(2017 Replacement Volume and 2022 Supplement)
	32	+	FOR the purpose of altering the reimbursement levels for drug products that the Maryland 6
	33	+	Medical Assistance Program is required to establish and that pharmacy benefits 7
	34	+	managers that contract with a pharmacy on behalf of a managed care organization 8
	35	+	are required to reimburse the pharmacy; altering the definition of “purchaser” for 9
	36	+	purposes of certain provisions of law regulating pharmacy benefits managers to 10
	37	+	include certain insurers, nonprofit health services plans, and health maintenance 11
	38	+	organizations requiring the Maryland Department of Health and the Prescription 12
	39	+	Drug Affordability Board jointly to study certain information regarding the payment 13
	40	+	of prescription drug claims under the Maryland Medical Assistance Program during 14
	41	+	certain calendar years and how to address certain inconsistencies; and generally 15
	42	+	relating to pharmacy benefits administration managed care organizations and the 16
	43	+	payment of prescription drug claims. 17
44	44
45		-	BY adding to
46		-	Article – Insurance
47		-	Section 15–1632
48		-	Annotated Code of Maryland
49		-	(2017 Replacement Volume and 2022 Supplement) Ch. 217 2023 LAWS OF MARYLAND
	45	+	BY repealing and reenacting, with amendments, 18
	46	+	Article – Health – General 19
	47	+	Section 15–118(b) 20
	48	+	Annotated Code of Maryland 21 2 HOUSE BILL 382
50	49
51		-	– 2 –
52	50
53		-	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND,
54		-	That the Laws of Maryland read as follows:
	51	+	(2019 Replacement Volume and 2022 Supplement) 1
55	52
56		-	Article – Health – General
	53	+	BY adding to 2
	54	+	Article – Health – General 3
	55	+	Section 15–118(f) 4
	56	+	Annotated Code of Maryland 5
	57	+	(2019 Replacement Volume and 2022 Supplement) 6
57	58
58		-	15–118.
	59	+	BY repealing and reenacting, with amendments, 7
	60	+	Article – Insurance 8
	61	+	Section 15–1601(s) 9
	62	+	Annotated Code of Maryland 10
	63	+	(2017 Replacement Volume and 2022 Supplement) 11
59	64
60		-	~~(b) (1) [Except] SUBJECT~~ TO ~~PARAGRAPH (2) OF THIS SUBSECTION A ND~~
61		-	~~EXCEPT as provided under paragraph [(2)] (3) of this subsection, the Program shall~~
62		-	~~establish [maximum] reimbursement levels for the drug products for which there is a~~
63		-	~~generic equivalent authorized under § 12–504~~ of ~~the Health Occupations Article[, based on~~
64		-	~~the cost of the generic product].~~
	65	+	BY adding to 12
	66	+	Article – Insurance 13
	67	+	Section 15–1632 14
	68	+	Annotated Code of Maryland 15
	69	+	(2017 Replacement Volume and 2022 Supplement) 16
65	70
66		-	(2) EXCEPT AS PROVIDED IN PARAGRAPH (4) OF THIS SUBSECTION ,
67		-	MINIMUM REIMBURSEMEN T LEVELS ESTABLISHED UNDER PARAGRAPH (1) OF THIS
68		-	SUBSECTION SHALL BE AT LEAST EQUAL TO THE NATIONAL AVERAGE DRUG
69		-	ACQUISITION COST OF THE GENERIC P RODUCT PLUS THE
70		-	FEE–FOR–SERVICE PROFESSIONAL DISPENSING FEE DETER MINED BY THE
71		-	DEPARTMENT IN ACCORDA NCE WITH THE MOST RE CENT IN –STATE
72		-	COST–OF–DISPENSING SURVEY .
	71	+	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 17
	72	+	That the Laws of Maryland read as follows: 18
73	73
74		-	[(2)] (3) [If] EXCEPT AS PROVIDED IN PARAG RAPH (4) OF THIS
75		-	SUBSECTION, IF a prescriber directs a specific brand name drug, the reimbursement level
76		-	shall be based on the [cost] NATIONAL AVERAGE DRUG ACQUISITION COST of the
77		-	brand name product PLUS THE FEE–FOR–SERVICE PROFESSIONAL DISPENSING FEE
78		-	DETERMINED BY THE DEPARTMENT IN ACCORDA NCE WITH THE MOST RE CENT
79		-	IN–STATE COST–OF–DISPENSING SURVEY .
	74	+	Article – Health – General 19
80	75
81		-	~~(4) PARAGRAPHS (2) AND (3) OF THIS SUBSECTION D O NOT APPLY TO:~~
	76	+	15–118. 20
82	77
83		-	(I) A PHARMACY OWNED BY , OR UNDER THE SAME CO RPORATE
84		-	AFFILIATION, AS A PHARMACY BENEFITS MANAGER; OR
	78	+	(b) (1) [Except] SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION A ND 21
	79	+	EXCEPT as provided under paragraph [(2)] (3) of this subsection, the Program shall 22
	80	+	establish [maximum] reimbursement levels for the drug products for which there is a 23
	81	+	generic equivalent authorized under § 12–504 of the Health Occupations Article[, based on 24
	82	+	the cost of the generic product]. 25
85	83
86		-	(II) A MAIL ORDER PHARMACY .
	84	+	(2) EXCEPT AS PROVIDED IN PARAGRAPH (4) OF THIS SUBSECTION , 26
	85	+	MINIMUM REIMBURSEMEN T LEVELS ESTABLISHED UNDER PARAGRAPH (1) OF THIS 27
	86	+	SUBSECTION SHALL BE AT LEAST EQUAL TO THE NATIONAL AVERAGE DRUG 28
	87	+	ACQUISITION COST OF THE GENERIC P RODUCT PLUS THE 29
	88	+	FEE–FOR–SERVICE PROFESSIONAL DISPENSING FEE DETER MINED BY THE 30
	89	+	DEPARTMENT IN ACCORDA NCE WITH THE MOST RE CENT IN –STATE 31
	90	+	COST–OF–DISPENSING SURVEY . 32
87	91
88		-	(F) ~~THE PROVISIONS~~ OF ~~§ 15–1632 OF THE INSURANCE ARTICLE APPLY TO~~
89		-	~~A MANAGED CARE ORGAN IZATION THAT USES~~ A ~~PHARMACY BENEFITS MA NAGER TO~~
90		-	~~MANAGE PRESCRIPTION~~ DRUG ~~COVERAGE BENEFI TS ON BEHALF~~ OF THE ~~MANAGED~~
91		-	~~CARE ORGANIZATION .~~
	92	+	[(2)] (3) [If] EXCEPT AS PROVIDED IN PARAGRAPH (4) OF THIS 33
	93	+	SUBSECTION, IF a prescriber directs a specific brand name drug, the reimbursement level 34
	94	+	shall be based on the [cost] NATIONAL AVERAGE DRUG ACQUISITION COST of the 35
	95	+	brand name product PLUS THE FEE–FOR–SERVICE PROFESS IONAL DISPENSING FEE 36 HOUSE BILL 382 3
92	96
93		-	Article – Insurance
94	97
95		-	15–1601. WES MOORE, Governor Ch. 217
	98	+	DETERMINED BY THE DEPARTMENT IN ACCORDA NCE WITH THE MOST RE CENT 1
	99	+	IN–STATE COST–OF–DISPENSING SURVEY . 2
96	100
97		-	– 3 –
	101	+	(4) PARAGRAPHS (2) AND (3) OF THIS SUBSECTION D O NOT APPLY TO: 3
98	102
99		-	(s) (1) “Purchaser” means a person that offers a plan or program in the State,
100		-	including the State Employee and Retiree Health and Welfare Benefits Program, AN
101		-	INSURER, A NONPROFIT HEALTH S ERVICE PLAN , OR A HEALTH MAINTENA NCE
102		-	ORGANIZATION , that:
	103	+	(I) A PHARMACY OWNED BY , OR UNDER THE SAME CO RPORATE 4
	104	+	AFFILIATION, AS A PHARMACY BENEFI TS MANAGER; OR 5
103	105
104		-	~~[(1)]~~ (I) ~~provides prescription drug coverage or benefits in the State; and~~
	106	+	(II) A MAIL ORDER PHARMACY . 6
105	107
106		-	[(2)] (II) enters into an agreement with a pharmacy benefits manager for
107		-	the provision of pharmacy benefits management services.
	108	+	(F) THE PROVISIONS OF § 15–1632 OF THE INSURANCE ARTICLE APPLY TO 7
	109	+	A MANAGED CARE ORGAN IZATION THAT USES A PHARMACY BENEFITS MA NAGER TO 8
	110	+	MANAGE PRESCRIPTION DRUG COVERAGE BENEFI TS ON BEHALF OF THE MANAGE D 9
	111	+	CARE ORGANIZATION . 10
108	112
109		-	(2) “PURCHASER” DOES NOT INCLUDE A N ONPROFIT HEALTH
110		-	MAINTENANCE ORGANIZA TION THAT:
	113	+	Article – Insurance 11
111	114
112		-	~~(I) OPERATES AS A GROUP MODEL;~~
	115	+	15–1601. 12
113	116
114		-	(II) PROVIDES SERVICES SO LELY TO A MEMBER OR PATIENT OF
115		-	THE NONPROFIT HEALTH MAINTENANCE ORGANIZA TION; AND
	117	+	(s) (1) “Purchaser” means a person that offers a plan or program in the State, 13
	118	+	including the State Employee and Retiree Health and Welfare Benefits Program, AN 14
	119	+	INSURER, A NONPROFIT H EALTH SERVICE PLAN , OR A HEALTH MAINTENA NCE 15
	120	+	ORGANIZATION , that: 16
116	121
117		-	(III) FURNISHES SERVICES T HROUGH THE INTERNAL PHARMACY
118		-	OPERATIONS OF THE NO NPROFIT HEALTH MAINT ENANCE ORGANIZATION .
	122	+	[(1)] (I) provides prescription drug coverage or benefits in the State; and 17
119	123
120		-	15–1632.
	124	+	[(2)] (II) enters into an agreement with a pharmacy benefits manager for 18
	125	+	the provision of pharmacy benefits management services. 19
121	126
122		-	A PHARMACY BENEFITS MA NAGER THAT CONTRACTS WITH A PHARMACY ON
123		-	BEHALF OF A MANAGED CARE ORGANIZATION , AS DEFINED IN § 15–101 OF THE
124		-	HEALTH – GENERAL ARTICLE, SHALL REIMBURSE THE PHARMACY AN AMOUNT
125		-	THAT IS AT LEAST EQU AL TO THE NATIONAL AVERAGE DRUG ACQUISITION COST
126		-	PLUS THE FEE–FOR–SERVICE PROFESSIONAL DISPENSING FEE DETER MINED BY THE
127		-	MARYLAND DEPARTMENT OF HEALTH FOR THE MARYLAND MEDICAL ASSISTANCE
128		-	PROGRAM IN ACCORDANCE WITH THE MOST RECENT IN–STATE
129		-	COST–OF–DISPENSING SURVEY .
	127	+	(2) “PURCHASER” DOES NOT INCLUDE A N ONPROFIT HEALTH 20
	128	+	MAINTENANCE ORGANIZA TION THAT: 21
130	129
131		-	(a) The Maryland Department of Health and the Prescription Drug Affordability
132		-	Board jointly shall study:
	130	+	(I) OPERATES AS A GROUP MODEL; 22
133	131
134		-	(1) ~~(i) the total amount the managed care organizations in the State~~
135		-	~~paid pharmacies for prescription drug claims in calendar years 2021 and 2022~~; and
	132	+	(II) PROVIDES SERVICES SO LELY TO A MEMBER OR PATIENT OF 23
	133	+	THE NONPROFIT HEALTH MAINTENANCE ORGANIZA TION; AND 24
136	134
137		-	(ii) what the total amount paid to pharmacies would have been, in
138		-	calendar years 2021 and 2022, if the prescription drug claims had been reimbursed at the
139		-	Maryland Medical Assistance Program fee–for–service rates; and
	135	+	(III) FURNISHES SERVICES T HROUGH THE INTERNAL PHARMACY 25
	136	+	OPERATIONS OF THE NO NPROFIT HEALTH MAINT ENANCE ORGANIZATION . 26
140	137
141		-	(2) how to best address the inconsistency in the amounts studied under
142		-	item (1) of this subsection by: Ch. 217 2023 LAWS OF MARYLAND
	138	+	15–1632. 27
143	139
144		-	– 4 –
	140	+	A PHARMACY BENEFITS MA NAGER THAT CONTRACTS WITH A PHARMACY ON 28
	141	+	BEHALF OF A MANAGED CARE ORGANIZATION , AS DEFINED IN § 15–101 OF THE 29
	142	+	HEALTH – GENERAL ARTICLE, SHALL REIMBURSE THE PHARMACY AN AMOUNT 30 4 HOUSE BILL 382
145	143
146		-	(i) considering the total cost to the State; and
147	144
148		-	(ii) recommending a methodology for determining the most accurate
149		-	ingredient cost of a drug and an appropriate dispensing fee.
	145	+	THAT IS AT LEAST EQU AL TO THE NATIONAL AVERAGE DRUG ACQUISITION COST 1
	146	+	PLUS THE FEE–FOR–SERVICE PROFESSIONAL DISPENSING FEE DETER MINED BY THE 2
	147	+	MARYLAND DEPARTMENT OF HEALTH FOR THE MARYLAND MEDICAL ASSISTANCE 3
	148	+	PROGRAM IN ACCORDANCE WITH THE MOST RECENT IN–STATE 4
	149	+	COST–OF–DISPENSING SURVEY . 5
150	150
151		-	(b) On or before October 31, 2023, the Maryland Department of Health and the
152		-	Prescription Drug Affordability Board jointly shall report its findings to the Maryland
153		-	Medicaid Administration and, in accordance with § 2–1257 of the State Government
154		-	Article, the Senate Budget and Taxation Committee, the Senate Finance Committee, the
155		-	House Appropriations Committee, and the House Health and Government Operat ions
156		-	Committee.
	151	+	(a) The Maryland Department of Health and the Prescription Drug Affordability 6
	152	+	Board jointly shall study: 7
157	153
158		-	SECTION 2. AND BE IT FURTHER ENACTED, That this Act is an emergency
159		-	measure, is necessary for the immediate preservation of the public health or safety, has
160		-	been passed by a yea and nay vote supported by three–fifths of all the members elected to
161		-	each of the two Houses of the General Assembly, and shall take effect from the date it is
162		-	enacted.
	154	+	(1) (i) the total amount the managed care organizations in the State 8
	155	+	paid pharmacies for prescription drug claims in calendar years 2021 and 2022; and 9
163	156
164		-	Approved by the Governor, April 24, 2023.
	157	+	(ii) what the total amount paid to pharmacies would have been, in 10
	158	+	calendar years 2021 and 2022, if the prescription drug claims had been reimbursed at the 11
	159	+	Maryland Medical Assistance Program fee–for–service rates; and 12
	160	+
	161	+	(2) how to best address the inconsistency in the amounts studied under 13
	162	+	item (1) of this subsection by: 14
	163	+
	164	+	(i) considering the total cost to the State; and 15
	165	+
	166	+	(ii) recommending a methodology for determining the most accurate 16
	167	+	ingredient cost of a drug and an appropriate dispensing fee. 17
	168	+
	169	+	(b) On or before October 31, 2023, the Maryland Department of Health and the 18
	170	+	Prescription Drug Affordability Board jointly shall report its findings to the Maryland 19
	171	+	Medicaid Administration and, in accordance with § 2–1257 of the State Government 20
	172	+	Article, the Senate Budget and Taxation Committee, the Senate Finance Committee, the 21
	173	+	House Appropriations Committee, and the House Health and Government Operat ions 22
	174	+	Committee. 23
	175	+
	176	+	SECTION 2. AND BE IT FURTHER ENACTED, That this Act is an emergency 24
	177	+	measure, is necessary for the immediate preservation of the public health or safety, has 25
	178	+	been passed by a yea and nay vote supported by three–fifths of all the members elected to 26
	179	+	each of the two Houses of the General Assembly, and shall take effect from the date it is 27
	180	+	enacted. 28
	181	+
	182	+
	183	+