EXPLANATION: CAPITALS INDICATE MAT TER ADDED TO EXISTIN G LAW.
[Brackets] indicate matter deleted from existing law.
*hb0539*
HOUSE BILL 539
J5, J4 3lr0777
HB 755/22 – HGO CF 3lr3007
By: Delegates M. Morgan and Kipke
Introduced and read first time: February 1, 2023
Assigned to: Health and Government Operations
A BILL ENTITLED
AN ACT concerning 1
Pharmacy Benefits Managers – Prohibited Actions 2
FOR the purpose of prohibiting a pharmacy benefits manager from taking certain actions 3
related to pricing, the participation of a pharmacy or pharmacist in a policy or 4
contract with the pharmacy benefits manager, fees, and the use of a mail order 5
pharmacy by beneficiaries; providing that certain provisions of this Act apply to 6
pharmacy benefits managers that contract with managed care organizations in the 7
same manner as they apply to pharmacy benefits managers that contract with 8
carriers; prohibiting all pharmacy benefits managers from taking certain actions 9
related to the use of specific pharmacies or entities to fill prescriptions, the provision 10
and discussion of certain price and cost share information by pharmacies and 11
pharmacists, and the sale of certain alternative drugs; and generally relating to 12
pharmacy benefits managers. 13
BY adding to 14
Article – Health – General 15
Section 15–102.3(k) 16
Annotated Code of Maryland 17
(2019 Replacement Volume and 2022 Supplement) 18
BY repealing and reenacting, without amendments, 19
Article – Insurance 20
Section 15–1601(a) 21
Annotated Code of Maryland 22
(2017 Replacement Volume and 2022 Supplement) 23
BY repealing and reenacting, with amendments, 24
Article – Insurance 25
Section 15–1601(s), (u), (v), and (w), 15–1611, and 15–1611.1 26
Annotated Code of Maryland 27
(2017 Replacement Volume and 2022 Supplement) 28 2 HOUSE BILL 539
BY adding to 1
Article – Insurance 2
Section 15–1601(u) 3
Annotated Code of Maryland 4
(2017 Replacement Volume and 2022 Supplement) 5
SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 6
That the Laws of Maryland read as follows: 7
Article – Health – General 8
15–102.3. 9
(K) THE PROVISIONS OF § 15–1611(B) OF THE INSURANCE ARTICLE APPLY 10
TO PHARMACY BENEFITS MANAGERS THAT CONTRA CT WITH MANAGED CARE 11
ORGANIZATIONS IN THE SAME MANNER AS THEY APPLY TO PHARMACY BE NEFITS 12
MANAGERS THAT CONTRA CT WITH CARRIERS . 13
Article – Insurance 14
15–1601. 15
(a) In this subtitle the following words have the meanings indicated. 16
(s) “Purchaser” means a person that offers a plan or program in the State, 17
including the State Employee and Retiree Health and Welfare Benefits Program, AN 18
INSURER, A NONPROFIT HEALTH SERVICE PLAN , OR A HEALTH MAINTENA NCE 19
ORGANIZATION that: 20
(1) provides prescription drug coverage or benefits in the State; and 21
(2) enters into an agreement with a pharmacy benefits manager for the 22
provision of pharmacy benefits management services. 23
(U) “SPREAD PRICING ” MEANS THE MODEL OF P RESCRIPTION DRUG 24
PRICING IN WHICH A P HARMACY BENEFITS MAN AGER CHARGES A PURCH ASER A 25
CONTRACTED PRICE FOR A PRESCRIPTION DRUG THAT DIFFERS FROM TH E AMOUNT 26
THE PHARMACY BENEFIT S MANAGER DIRECTLY O R INDIRECTLY PAYS THE 27
PHARMACIST OR PHARMA CY FOR THE PRESCRIPT ION DRUG DISPENSED B Y THE 28
PHARMACIST OR PHARMA CY. 29
[(u)] (V) (1) “Therapeutic interchange” means any change from one 30
prescription drug to another. 31
(2) “Therapeutic interchange” does not include: 32 HOUSE BILL 539 3
(i) a change initiated pursuant to a drug utilization review; 1
(ii) a change initiated for patient safety reasons; 2
(iii) a change required due to market unavailability of the currently 3
prescribed drug; 4
(iv) a change from a brand name drug to a generic drug in accordance 5
with § 12–504 of the Health Occupations Article; or 6
(v) a change required for coverage reasons because the originally 7
prescribed drug is not covered by the beneficiary’s formulary or plan. 8
[(v)] (W) “Therapeutic interchange solicitation” means any communication by a 9
pharmacy benefits manager for the purpose of requesting a therapeutic interchange. 10
[(w)] (X) “Trade secret” has the meaning stated in § 11–1201 of the Commercial 11
Law Article. 12
15–1611. 13
[(a) This section applies only to a pharmacy benefits manager that provides 14
pharmacy benefits management services on behalf of a carrier.] 15
[(b)] (A) A pharmacy benefits manager may not prohibit a pharmacy or 16
pharmacist from: 17
(1) providing a beneficiary with information regarding the retail price for 18
a prescription drug or the amount of the cost share for which the beneficiary is responsible 19
for a prescription drug; 20
(2) discussing with a beneficiary information regarding the retail price for 21
a prescription drug or the amount of the cost share for which the beneficiary is responsible 22
for a prescription drug; or 23
(3) if a more affordable drug is available than one on the purchaser’s 24
formulary and the requirements for a therapeutic interchange under §§ 15–1633.1 through 25
15–1639 of this subtitle are met, selling the more affordable alternative to the beneficiary. 26
(B) A PHARMACY BENEFITS MA NAGER MAY NOT : 27
(1) ENGAGE IN THE PRACTI CE OF SPREAD PRICING ; 28
(2) DENY ANY PHARMACY TH E RIGHT TO PARTICIPA TE IN A POLICY OR 29
CONTRACT WITH THE PH ARMACY BENEFITS MANA GER IF THE PHARMACY OR 30 4 HOUSE BILL 539
PHARMACIST AGREES TO MEET THE TERMS AND C ONDITIONS OF THE POL ICY OR 1
CONTRACT; 2
(3) TAKE MORE THAN 30 DAYS TO REVIEW THE A PPLICATION O F A 3
PHARMACY OR PHARMACI ST TO PARTICIPATE IN A POLICY OR CONTRACT WITH THE 4
PHARMACY BENEFITS MA NAGER; OR 5
(4) SET DIFFERENT FEES F OR A BENEFICIARY ’S COPAY BASED ON 6
WHETHER A PHARMACY O R PHARMACIST IS AFFI LIATED WITH AN INDEP ENDENT OR 7
CHAIN PHARMACY . 8
(c) This section may not be construed to alter the requirements for a therapeutic 9
interchange under §§ 15–1633.1 through 15–1639 of this subtitle. 10
(D) THIS SECTION MAY NOT BE CONSTRUED TO PREE MPT OR CONFLICT 11
WITH ANY FEDERAL LAW OR REGULATION . 12
15–1611.1. 13
[(a) This section applies only to a pharmacy benefits manager that provides 14
pharmacy benefits management services on behalf of a carrier.] 15
[(b)] (A) Except as provided in subsection (B) OF THIS SECTION AND SUBJECT 16
TO SUBSECTION (c) of this section, a pharmacy benefits manager may not require that a 17
beneficiary use a specific pharmacy or entity to fill a prescription if: 18
(1) the pharmacy benefits manager or a corporate affiliate of the pharmacy 19
benefits manager has an ownership interest in the pharmacy or entity; or 20
(2) the pharmacy or entity has an ownership interest in the pharmacy 21
benefits manager or a corporate affiliate of the pharmacy benefits manager. 22
[(c)] (B) A pharmacy benefits manager may require a beneficiary to use a 23
specific pharmacy or entity for a specialty drug as defined in § 15–847 of this title. 24
(C) A PHARMACY BENEFITS MA NAGER MAY NOT REQUIR E THAT A 25
BENEFICIARY USE A MA IL ORDER PHARMACY TO FILL A PRESCRIPTION . 26
SECTION 2. AND BE IT FURTHER ENACTED, T hat this Act shall apply to all 27
policies or contracts issued, delivered, or renewed in the State on or after January 1, 2024. 28
SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 29
January 1, 2024. 30