Maryland 2023 Regular Session

Maryland Senate Bill SB64 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	sb0064
6	6
7	7	SENATE BILL 64
8	8	J2, J5, J4 3lr0314
9	9	SB 355/22 – EHE & FIN (PRE–FILED)
10	10	By: Senator Lam
11	11	Requested: July 6, 2022
12	12	Introduced and read first time: January 11, 2023
13	13	Assigned to: Finance
14	14
15	15	A BILL ENTITLED
16	16
17	17	AN ACT concerning 1
18	18
19	19	HIV Prevention Drugs – Prescribing and Dispensing by Pharmacists and 2
20	20	Insurance Requirements 3
21	21
22	22	FOR the purpose of authorizing pharmacists to prescribe and dispense postexposure 4
23	23	prophylaxis for HIV prevention to patients under certain circumstances; requiring 5
24	24	the Maryland Medical Assistance Program to provide drugs that are approved by the 6
25	25	U.S. Food and Drug Administration for HIV prevention; prohibiting managed care 7
26	26	organizations, insurers, nonprofit health service plans, and health maintenance 8
27	27	organizations from requiring prior authorization for preexposure prophylaxis for 9
28	28	HIV prevention or step therapy or cost–sharing for preexposure prophylaxis for HIV 10
29	29	prevention or postexposure prophylaxis for HIV prevention; and generally relating 11
30	30	to HIV prevention drugs. 12
31	31
32	32	BY adding to 13
33	33	Article – Health – General 14
34	34	Section 15–102.3(k) and 15–103(a)(2)(xxii) 15
35	35	Annotated Code of Maryland 16
36	36	(2019 Replacement Volume and 2022 Supplement) 17
37	37
38	38	BY repealing and reenacting, without amendments, 18
39	39	Article – Health – General 19
40	40	Section 15–103(a)(1) 20
41	41	Annotated Code of Maryland 21
42	42	(2019 Replacement Volume and 2022 Supplement) 22
43	43
44	44	BY repealing and reenacting, with amendments, 23
45	45	Article – Health – General 24
46	46	Section 15–103(a)(2)(xx) and (xxi) and (b)(32) 25
47	47	Annotated Code of Maryland 26
48	48	(2019 Replacement Volume and 2022 Supplement) 27 2 SENATE BILL 64
49	49
50	50
51	51
52	52	BY repealing and reenacting, with amendments, 1
53	53	Article – Health Occupations 2
54	54	Section 12–101(x)(1)(xii) and (xiii) 3
55	55	Annotated Code of Maryland 4
56	56	(2021 Replacement Volume and 2022 Supplement) 5
57	57
58	58	BY adding to 6
59	59	Article – Health Occupations 7
60	60	Section 12–101(x)(1)(xiv) and 12–515 8
61	61	Annotated Code of Maryland 9
62	62	(2021 Replacement Volume and 2022 Supplement) 10
63	63
64	64	BY repealing and reenacting, with amendments, 11
65	65	Article – Insurance 12
66	66	Section 15–858 13
67	67	Annotated Code of Maryland 14
68	68	(2017 Replacement Volume and 2022 Supplement) 15
69	69
70	70	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 16
71	71	That the Laws of Maryland read as follows: 17
72	72
73	73	Article – Health – General 18
74	74
75	75	15–103. 19
76	76
77	77	(a) (1) The Secretary shall administer the Maryland Medical Assistance 20
78	78	Program. 21
79	79
80	80	(2) The Program: 22
81	81
82	82	(xx) Beginning on July 1, 2023, shall provide, subject to federal 23
83	83	approval and limitations of the State budget, community violence prevention services in 24
84	84	accordance with § 15–141.3 of this subtitle; [and] 25
85	85
86	86	(xxi) Beginning on January 1, 2023, shall provide, subject to the 26
87	87	limitations of the State budget, and as permitted by federal law, coverage for self–measured 27
88	88	blood pressure monitoring for all Program recipients diagnosed with uncontrolled high 28
89	89	blood pressure, including: 29
90	90
91	91	1. The provision of validated home blood pressure monitors; 30
92	92	and 31
93	93
94	94	2. Reimbursement of health care provider and other staff 32
95	95	time used for patient training, transmission of blood pressure data, interpretation of blood 33
96	96	pressure readings and reporting, and the delivery of co –interventions, including 34
97	97	educational materials or classes, behavioral change management, and medication 35 SENATE BILL 64 3
98	98
99	99
100	100	management; AND 1
101	101
102	102	(XXII) SHALL PROVIDE , SUBJECT TO THE LIMIT ATIONS OF 2
103	103	THE STATE BUDGET , MEDICALLY APPROPRIAT E DRUGS THAT ARE APP ROVED BY 3
104	104	THE U.S. FOOD AND DRUG ADMINISTRATION FOR HIV PREVENTION , INCLUDING: 4
105	105
106	106	1. PREEXPOSURE PROPHYLAX IS; AND 5
107	107
108	108	2. POSTEXPOSURE PROPHYLA XIS, AS DEFINED IN § 6
109	109	12–515 OF THE HEALTH OCCUPATIONS ARTICLE. 7
110	110
111	111	(b) (32) A managed care organization may not apply a prior authorization 8
112	112	requirement for a prescription drug used as PREEXPOSURE PROPHYLA XIS OR 9
113	113	postexposure prophylaxis for the prevention of HIV if the prescription drug is prescribed 10
114	114	for use in accordance with Centers for Disease Control and Prevention Guidelines. 11
115	115
116	116	Article – Health Occupations 12
117	117
118	118	12–101. 13
119	119
120	120	(x) (1) “Practice pharmacy” means to engage in any of the following activities: 14
121	121
122	122	(xii) Prescribing and dispensing contraceptive medications and 15
123	123	self–administered contraceptive devices approved by the U.S. Food and Drug 16
124	124	Administration; [or] 17
125	125
126	126	(xiii) Prescribing and dispensing nicotine replacement therapy 18
127	127	medications; OR 19
128	128
129	129	(XIV) PRESCRIBING AND DISPE NSING POSTEXPOSURE 20
130	130	PROPHYLAXIS MEDICATI ONS FOR HIV APPROVED BY THE U.S. FOOD AND DRUG 21
131	131	ADMINISTRATION . 22
132	132
133	133	12–515. 23
134	134
135	135	(A) (1) IN THIS SECTION THE F OLLOWING WO RDS HAVE THE MEANING S 24
136	136	INDICATED. 25
137	137
138	138	(2) “CDC GUIDELINES FOR POSTE XPOSURE PROPHYLAXIS ” MEANS 26
139	139	“UPDATED GUIDELINES FOR ANTIRETROVIRAL POSTEXPOSURE PROPHYLAXIS 27
140	140	AFTER SEXUAL, INJECTION DRUG USE, OR OTHER NONOCCUPATIONAL EXPOSURE 28
141	141	TO HIV – UNITED STATES, 2016” OR ANY SUBSEQUENT GUIDE LINES PUBLISHED BY 29
142	142	THE FEDERAL CENTERS FOR DISEASE CONTROL AND PREVENTION. 30
143	143
144	144	(3) “CDC GUIDELINES FOR PREEX POSURE PROPHYLAXIS ” MEANS 31 4 SENATE BILL 64
145	145
146	146
147	147	“PREEXPOSURE PROPHYLAXIS FOR THE PREVENTION OF HIV INFECTION IN THE 1
148	148	UNITED STATES – 2017 UPDATE: A CLINICAL PRACTICE GUIDELINE” OR ANY 2
149	149	SUBSEQUENT GUIDELINE S PUBLISHED BY THE F EDERAL CENTERS FOR DISEASE 3
150	150	CONTROL AND PREVENTION. 4
151	151
152	152	(4) “POSTEXPOSURE PROPHYLA XIS” MEANS ANY DRUG 5
153	153	COMBINATION APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION THAT I S: 6
154	154
155	155	(I) USED TO PREVENT HIV INFECTION FOLLOWING AN 7
156	156	EXPOSURE OR POTENTIA L EXPOSURE TO HIV; AND 8
157	157
158	158	(II) ADMINISTERED IN ACCOR DANCE WITH THE CDC, IN THE 9
159	159	CDC GUIDELINES FOR POSTE XPOSURE PROPHYLAXIS . 10
160	160
161	161	(5) “PREEXPOSURE PROPHYLAX IS” MEANS ANY DRUG COMBI NATION 11
162	162	APPROVED BY THE U.S. FOOD AND DRUG ADMINISTRATION THAT I S: 12
163	163
164	164	(I) PROVIDED TO AN HIV–NEGATIVE PERSON TO P REVENT 13
165	165	HIV INFECTION; AND 14
166	166
167	167	(II) ADMINISTERED IN ACCOR DANCE WITH THE CDC, IN THE 15
168	168	CDC GUIDELINES FOR PREEXP OSURE PROPHYLAXIS . 16
169	169
170	170	(6) “RYAN WHITE HIV/AIDS PROGRAM” MEANS THE PROGRAM 17
171	171	ADMINISTERED BY THE FEDERAL HEALTH RESOURCES AND SERVICES 18
172	172	ADMINISTRATION THAT P ROVIDES GRANTS TO PR OVIDE CARE AND TREAT MENT 19
173	173	SERVICES TO INDIVIDU ALS WITH HIV TO IMPROVE HEALTH OU TCOMES AND 20
174	174	REDUCE HIV TRANSMISSION AMONG H ARD–TO–REACH POPU LATIONS. 21
175	175
176	176	(B) (1) A PHARMACIST MAY PRESC RIBE AND DISPENSE A COMPLETE 22
177	177	COURSE OF POSTEXPOSU RE PROPHYLAXIS TO A PATIENT IF THE PHARM ACIST: 23
178	178
179	179	(I) SCREENS THE PATIENT A ND DETERMINES : 24
180	180
181	181	1. THE EXPOSURE TO HIV OCCURRED WITHIN THE 25
182	182	IMMEDIATELY PRECEDIN G 72 HOURS; AND 26
183	183
184	184	2. THE PATIENT OTHERWISE MEETS THE CLINICAL 27
185	185	CRITERIA FOR POSTEXP OSURE PROPHYLAXIS CO NSISTENT WITH THE CDC 28
186	186	GUIDELINES FOR POSTE XPOSURE PROPHYLAXIS ; 29
187	187
188	188	(II) 1. PROVIDES HIV TESTING THAT IS CLAS SIFIED AS 30
189	189	WAIVED UNDER THE FED ERAL CLINICAL LABORATORY IMPROVEMENT 31
190	190	AMENDMENTS OF 1988; OR 32 SENATE BILL 64 5
191	191
192	192
193	193
194	194	2. EXCEPT AS PROVIDED IN PARAGRAPH (3) OF THIS 1
195	195	SUBSECTION, OBTAINS THE CONSENT OF THE PATIENT TO SU BMIT TO AN HIV TEST 2
196	196	CONSISTENT WITH THE CDC GUIDELINES FOR POSTE XPOSURE PROPHYLAXIS ; 3
197	197
198	198	(III) PROVIDES COUNSE LING TO THE PATIENT ON: 4
199	199
200	200	1. THE USE OF POSTEXPOSU RE PROPHYLAXIS 5
201	201	CONSISTENT WITH THE CDC GUIDELINES FOR POSTE XPOSURE PROPHYLAXIS , 6
202	202	INCLUDING EDUCATION REGARDING SIDE EFFEC TS, SAFETY DURING PREGNA NCY 7
203	203	AND BREASTFEEDING , ADHERENCE TO RECOMME NDED DOSING , AND THE 8
204	204	IMPORTANCE OF TIMELY TESTING AND TREATMEN T, AS APPLICABLE, FOR HIV AND 9
205	205	SEXUALLY TRANSMITTED DISEASES; AND 10
206	206
207	207	2. THE AVAILABILITY OF P REEXPOSURE PROPHYLAX IS 11
208	208	FOR INDIVIDUALS WHO ARE AT SUBSTANTIAL R ISK OF CONTRACTING HIV; AND 12
209	209
210	210	(IV) PROVIDES: 13
211	211
212	212	1. NOTICE TO THE PATIENT ’S PRIMARY CARE PROVI DER 14
213	213	OF THE POSTEXPOSURE PROPHYLAXIS TREATMEN T; OR 15
214	214
215	215	2. IF THE PATIENT DOES N OT HAVE A PRIMARY CA RE 16
216	216	PROVIDER OR REFUSES TO PROVIDE THE NAME OF A HEALTH CARE PRO VIDER, THE 17
217	217	PATIENT WITH A LIST OF PHYSICIANS , CLINICS, OR OTHER HEALTH CARE 18
218	218	PROVIDERS IN THE ARE A, INCLUDING PROVIDERS THAT RECEIVE FUNDING , EITHER 19
219	219	DIRECTLY OR INDIRECT LY, FROM THE RYAN WHITE HIV/AIDS PROGRAM, TO 20
220	220	CONTACT REGARDING FO LLOW–UP CARE FOR POSTEXPO SURE PROPHYLAXIS . 21
221	221
222	222	(2) A PHARMACIST MAY NOT A LLOW A PATIENT TO REF USE OR WAIVE 22
223	223	A CONSULTATION REQUI RED UNDER PARAGRAPH (1) OF THIS SUBSECTION . 23
224	224
225	225	(3) IF THE PATIENT REFUSE S TO CONSENT TO AN HIV TEST UNDER 24
226	226	PARAGRAPH (1)(II)2 OF THIS SUBSECTION B UT OTHERWISE MEETS T HE CRITERIA 25
227	227	FOR POSTEXPOSURE PROPHYLAXIS UNDER TH IS SUBSECTION, THE PHARMACIST 26
228	228	MAY PRESCRIBE AND DI SPENSE POSTEXPOSURE PROPHYLAXIS TO THE P ATIENT. 27
229	229
230	230	(C) (1) (I) BEFORE PRESCRIBING AN D DISPENSING POSTEXP OSURE 28
231	231	PROPHYLAXIS TO A PAT IENT, A PHARMACIST SHALL COM PLETE A TRAINING 29
232	232	PROGRAM ON T HE AVAILABILITY OF PREE XPOSURE PROPHYLAXIS AND ON THE USE 30
233	233	OF POSTEXPOSURE PROP HYLAXIS THAT IS APPROVED BY THE BOARD. 31
234	234
235	235	(II) THE TRAINING PROGRAM REQUIRED UNDER 32
236	236	SUBPARAGRAPH (I) OF THIS PARAGRAPH SH ALL INCLUDE INFORMAT ION ABOUT 33 6 SENATE BILL 64
237	237
238	238
239	239	FINANCIAL ASSISTANCE PROGRAMS FOR PREEXPOSURE PROPHYLA XIS AND 1
240	240	POSTEXPOSURE PROPHYL AXIS. 2
241	241
242	242	(2) THE BOARD SHALL CONSULT W ITH THE STATE BOARD OF 3
243	243	PHYSICIANS, THE STATE BOARD OF NURSING, AND OTHER RELEVANT 4
244	244	STAKEHOLDERS , INCLUDING THE MARYLAND CENTER FOR HIV CARE SERVICES, 5
245	245	WHEN DEVELOPIN G OR APPROVING TRAIN ING PROGRAMS THAT ME ET THE 6
246	246	REQUIREMENTS OF THIS SUBSECTION. 7
247	247
248	248	(D) THE BOARD, IN CONSULTATION WITH THE STATE BOARD OF 8
249	249	PHYSICIANS AND THE STATE BOARD OF NURSING, SHALL ADOPT REGULATI ONS 9
250	250	ESTABLISHING PROCEDU RES FOR CREATING AND DISSEMINATING A LIST OF 10
251	251	ENTITIES THAT RECEIV E FUNDING, EITHER DIRECTLY OR I NDIRECTLY, FROM THE 11
252	252	RYAN WHITE HIV/AIDS PROGRAM. 12
253	253
254	254	SECTION 2. AND BE IT FURTHER ENACTED, That the Laws of Maryland read 13
255	255	as follows: 14
256	256
257	257	Article – Health – General 15
258	258
259	259	15–102.3. 16
260	260
261	261	(K) THE PROVISIONS OF § 15–858 OF THE INSURANCE ARTICLE APPLY TO 17
262	262	MANAGED CARE ORGANIZ ATIONS IN THE SAME M ANNER AS THEY APPLY TO 18
263	263	CARRIERS. 19
264	264
265	265	Article – Insurance 20
266	266
267	267	15–858. 21
268	268
269	269	(a) (1) [This] EXCEPT AS PROVIDED IN PARAGRAPH (3) OF THIS 22
270	270	SUBSECTION, THIS section applies to: 23
271	271
272	272	(i) insurers and nonprofit health service plans that provide coverage 24
273	273	for prescription drugs under individual, group, or blanket health insurance policies or 25
274	274	contracts that are issued or delivered in the State; and 26
275	275
276	276	(ii) health maintenance organizations that provide coverage for 27
277	277	prescription drugs under individual or group contracts that are issued or delivered in the 28
278	278	State. 29
279	279
280	280	(2) An insurer, a nonprofit health service plan, or a health maintenance 30
281	281	organization that provides coverage for prescription drugs through a pharmacy benefits 31
282	282	manager is subject to the requirements of this section. 32
283	283	SENATE BILL 64 7
284	284
285	285
286	286	(3) THIS SECTION DOES NOT APPLY TO A GRANDFATH ERED PLAN, AS 1
287	287	DEFINED IN § 1251 OF THE AFFORDABLE CARE ACT. 2
288	288
289	289	(b) An entity subject to this section may not apply a prior authorization 3
290	290	requirement OR STEP THERAPY OR I MPOSE ANY COST –SHARING REQUIREMENTS , 4
291	291	INCLUDING COPAYMENTS , COINSURANCE , OR DEDUCTIBLES , for a prescription drug 5
292	292	used as PREEXPOSURE PROPHYLA XIS OR postexposure prophylaxis for the prevention of 6
293	293	HIV if the prescription drug is prescribed for use in accordance with Centers for Disease 7
294	294	Control and Prevention guidelines. 8
295	295
296	296	(C) AN ENTITY SUBJECT TO THIS SECTION MAY NOT IMPOSE ANY 9
297	297	COST–SHARING REQUIREMENTS , INCLUDING COPAYMENTS , COINSURANCE , OR 10
298	298	DEDUCTIBLES , FOR MEDICALLY NECESS ARY AND APPROPRIATE SERVICES RELATED 11
299	299	TO THE USE OF PREEXPOSURE PROPHYLA XIS OR POSTEXPOSURE PROPHYL AXIS, 12
300	300	INCLUDING: 13
301	301
302	302	(1) HIV TESTING; 14
303	303
304	304	(2) KIDNEY FUNCTION TESTING; 15
305	305
306	306	(3) ONGOING FOLLOW –UP AND MONITORING EV ERY 3 MONTHS; 16
307	307
308	308	(4) PREGNANCY TESTING ; 17
309	309
310	310	(5) PROVIDER OFFICE AND TELEHEALTH VISITS FO R PRESCRIBING 18
311	311	AND MEDICATION MANAG EMENT; 19
312	312
313	313	(6) SEROLOGIC LABORATORY TESTING FOR HEPATITI S B AND 20
314	314	HEPATITIS C VIRUSES; 21
315	315
316	316	(7) TESTING FOR OTHER SE XUALLY TRANSMITTED I NFECTIONS, 22
317	317	INCLUDING THREE –SITE TESTING FOR GON ORRHEA AND CHLAMYDIA ; AND 23
318	318
319	319	(8) VACCINATIONS FOR HEP ATITIS B. 24
320	320
321	321	SECTION 3. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall 25
322	322	apply to all policies, contracts, and health benefit plans that are not grandfathered plans 26
323	323	as defined in § 1251 of the Affordable Care Act issued, delivered, or renewed in the State 27
324	324	on or after January 1, 2024. 28
325	325
326	326	SECTION 4. AND BE IT FURTHER ENACTED, That Section 2 of this Act shall take 29
327	327	effect January 1, 2024. 30
328	328
329	329	SECTION 5. AND BE IT FURTHER ENACTED, That, except as provided in Section 31
330	330	4 of this Act, this Act shall take effect October 1, 2023. 32