Maryland 2023 Regular Session

Maryland House Bill HB539 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1
2	2
3	3	EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
4	4	[Brackets] indicate matter deleted from existing law.
5	5	hb0539
6	6
7	7	HOUSE BILL 539
8	8	J5, J4 3lr0777
9	9	HB 755/22 – HGO CF 3lr3007
10	10	By: Delegates M. Morgan and Kipke
11	11	Introduced and read first time: February 1, 2023
12	12	Assigned to: Health and Government Operations
13	13
14	14	A BILL ENTITLED
15	15
16	16	AN ACT concerning 1
17	17
18	18	Pharmacy Benefits Managers – Prohibited Actions 2
19	19
20	20	FOR the purpose of prohibiting a pharmacy benefits manager from taking certain actions 3
21	21	related to pricing, the participation of a pharmacy or pharmacist in a policy or 4
22	22	contract with the pharmacy benefits manager, fees, and the use of a mail order 5
23	23	pharmacy by beneficiaries; providing that certain provisions of this Act apply to 6
24	24	pharmacy benefits managers that contract with managed care organizations in the 7
25	25	same manner as they apply to pharmacy benefits managers that contract with 8
26	26	carriers; prohibiting all pharmacy benefits managers from taking certain actions 9
27	27	related to the use of specific pharmacies or entities to fill prescriptions, the provision 10
28	28	and discussion of certain price and cost share information by pharmacies and 11
29	29	pharmacists, and the sale of certain alternative drugs; and generally relating to 12
30	30	pharmacy benefits managers. 13
31	31
32	32	BY adding to 14
33	33	Article – Health – General 15
34	34	Section 15–102.3(k) 16
35	35	Annotated Code of Maryland 17
36	36	(2019 Replacement Volume and 2022 Supplement) 18
37	37
38	38	BY repealing and reenacting, without amendments, 19
39	39	Article – Insurance 20
40	40	Section 15–1601(a) 21
41	41	Annotated Code of Maryland 22
42	42	(2017 Replacement Volume and 2022 Supplement) 23
43	43
44	44	BY repealing and reenacting, with amendments, 24
45	45	Article – Insurance 25
46	46	Section 15–1601(s), (u), (v), and (w), 15–1611, and 15–1611.1 26
47	47	Annotated Code of Maryland 27
48	48	(2017 Replacement Volume and 2022 Supplement) 28 2 HOUSE BILL 539
49	49
50	50
51	51
52	52	BY adding to 1
53	53	Article – Insurance 2
54	54	Section 15–1601(u) 3
55	55	Annotated Code of Maryland 4
56	56	(2017 Replacement Volume and 2022 Supplement) 5
57	57
58	58	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 6
59	59	That the Laws of Maryland read as follows: 7
60	60
61	61	Article – Health – General 8
62	62
63	63	15–102.3. 9
64	64
65	65	(K) THE PROVISIONS OF § 15–1611(B) OF THE INSURANCE ARTICLE APPLY 10
66	66	TO PHARMACY BENEFITS MANAGERS THAT CONTRA CT WITH MANAGED CARE 11
67	67	ORGANIZATIONS IN THE SAME MANNER AS THEY APPLY TO PHARMACY BE NEFITS 12
68	68	MANAGERS THAT CONTRA CT WITH CARRIERS . 13
69	69
70	70	Article – Insurance 14
71	71
72	72	15–1601. 15
73	73
74	74	(a) In this subtitle the following words have the meanings indicated. 16
75	75
76	76	(s) “Purchaser” means a person that offers a plan or program in the State, 17
77	77	including the State Employee and Retiree Health and Welfare Benefits Program, AN 18
78	78	INSURER, A NONPROFIT HEALTH SERVICE PLAN , OR A HEALTH MAINTENA NCE 19
79	79	ORGANIZATION that: 20
80	80
81	81	(1) provides prescription drug coverage or benefits in the State; and 21
82	82
83	83	(2) enters into an agreement with a pharmacy benefits manager for the 22
84	84	provision of pharmacy benefits management services. 23
85	85
86	86	(U) “SPREAD PRICING ” MEANS THE MODEL OF P RESCRIPTION DRUG 24
87	87	PRICING IN WHICH A P HARMACY BENEFITS MAN AGER CHARGES A PURCH ASER A 25
88	88	CONTRACTED PRICE FOR A PRESCRIPTION DRUG THAT DIFFERS FROM TH E AMOUNT 26
89	89	THE PHARMACY BENEFIT S MANAGER DIRECTLY O R INDIRECTLY PAYS THE 27
90	90	PHARMACIST OR PHARMA CY FOR THE PRESCRIPT ION DRUG DISPENSED B Y THE 28
91	91	PHARMACIST OR PHARMA CY. 29
92	92
93	93	[(u)] (V) (1) “Therapeutic interchange” means any change from one 30
94	94	prescription drug to another. 31
95	95
96	96	(2) “Therapeutic interchange” does not include: 32 HOUSE BILL 539 3
97	97
98	98
99	99
100	100	(i) a change initiated pursuant to a drug utilization review; 1
101	101
102	102	(ii) a change initiated for patient safety reasons; 2
103	103
104	104	(iii) a change required due to market unavailability of the currently 3
105	105	prescribed drug; 4
106	106
107	107	(iv) a change from a brand name drug to a generic drug in accordance 5
108	108	with § 12–504 of the Health Occupations Article; or 6
109	109
110	110	(v) a change required for coverage reasons because the originally 7
111	111	prescribed drug is not covered by the beneficiary’s formulary or plan. 8
112	112
113	113	[(v)] (W) “Therapeutic interchange solicitation” means any communication by a 9
114	114	pharmacy benefits manager for the purpose of requesting a therapeutic interchange. 10
115	115
116	116	[(w)] (X) “Trade secret” has the meaning stated in § 11–1201 of the Commercial 11
117	117	Law Article. 12
118	118
119	119	15–1611. 13
120	120
121	121	[(a) This section applies only to a pharmacy benefits manager that provides 14
122	122	pharmacy benefits management services on behalf of a carrier.] 15
123	123
124	124	[(b)] (A) A pharmacy benefits manager may not prohibit a pharmacy or 16
125	125	pharmacist from: 17
126	126
127	127	(1) providing a beneficiary with information regarding the retail price for 18
128	128	a prescription drug or the amount of the cost share for which the beneficiary is responsible 19
129	129	for a prescription drug; 20
130	130
131	131	(2) discussing with a beneficiary information regarding the retail price for 21
132	132	a prescription drug or the amount of the cost share for which the beneficiary is responsible 22
133	133	for a prescription drug; or 23
134	134
135	135	(3) if a more affordable drug is available than one on the purchaser’s 24
136	136	formulary and the requirements for a therapeutic interchange under §§ 15–1633.1 through 25
137	137	15–1639 of this subtitle are met, selling the more affordable alternative to the beneficiary. 26
138	138
139	139	(B) A PHARMACY BENEFITS MA NAGER MAY NOT : 27
140	140
141	141	(1) ENGAGE IN THE PRACTI CE OF SPREAD PRICING ; 28
142	142
143	143	(2) DENY ANY PHARMACY TH E RIGHT TO PARTICIPA TE IN A POLICY OR 29
144	144	CONTRACT WITH THE PH ARMACY BENEFITS MANA GER IF THE PHARMACY OR 30 4 HOUSE BILL 539
145	145
146	146
147	147	PHARMACIST AGREES TO MEET THE TERMS AND C ONDITIONS OF THE POL ICY OR 1
148	148	CONTRACT; 2
149	149
150	150	(3) TAKE MORE THAN 30 DAYS TO REVIEW THE A PPLICATION O F A 3
151	151	PHARMACY OR PHARMACI ST TO PARTICIPATE IN A POLICY OR CONTRACT WITH THE 4
152	152	PHARMACY BENEFITS MA NAGER; OR 5
153	153
154	154	(4) SET DIFFERENT FEES F OR A BENEFICIARY ’S COPAY BASED ON 6
155	155	WHETHER A PHARMACY O R PHARMACIST IS AFFI LIATED WITH AN INDEP ENDENT OR 7
156	156	CHAIN PHARMACY . 8
157	157
158	158	(c) This section may not be construed to alter the requirements for a therapeutic 9
159	159	interchange under §§ 15–1633.1 through 15–1639 of this subtitle. 10
160	160
161	161	(D) THIS SECTION MAY NOT BE CONSTRUED TO PREE MPT OR CONFLICT 11
162	162	WITH ANY FEDERAL LAW OR REGULATION . 12
163	163
164	164	15–1611.1. 13
165	165
166	166	[(a) This section applies only to a pharmacy benefits manager that provides 14
167	167	pharmacy benefits management services on behalf of a carrier.] 15
168	168
169	169	[(b)] (A) Except as provided in subsection (B) OF THIS SECTION AND SUBJECT 16
170	170	TO SUBSECTION (c) of this section, a pharmacy benefits manager may not require that a 17
171	171	beneficiary use a specific pharmacy or entity to fill a prescription if: 18
172	172
173	173	(1) the pharmacy benefits manager or a corporate affiliate of the pharmacy 19
174	174	benefits manager has an ownership interest in the pharmacy or entity; or 20
175	175
176	176	(2) the pharmacy or entity has an ownership interest in the pharmacy 21
177	177	benefits manager or a corporate affiliate of the pharmacy benefits manager. 22
178	178
179	179	[(c)] (B) A pharmacy benefits manager may require a beneficiary to use a 23
180	180	specific pharmacy or entity for a specialty drug as defined in § 15–847 of this title. 24
181	181
182	182	(C) A PHARMACY BENEFITS MA NAGER MAY NOT REQUIR E THAT A 25
183	183	BENEFICIARY USE A MA IL ORDER PHARMACY TO FILL A PRESCRIPTION . 26
184	184
185	185	SECTION 2. AND BE IT FURTHER ENACTED, T hat this Act shall apply to all 27
186	186	policies or contracts issued, delivered, or renewed in the State on or after January 1, 2024. 28
187	187
188	188	SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 29
189	189	January 1, 2024. 30
190	190