Maryland 2023 Regular Session

Maryland Senate Bill SB895 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	sb0895
6	6
7	7	SENATE BILL 895
8	8	J5 EMERGENCY BILL 3lr3017
9	9	CF HB 382
10	10	By: Senators Ready and Klausmeier
11	11	Introduced and read first time: February 15, 2023
12	12	Assigned to: Rules
13	13
14	14	A BILL ENTITLED
15	15
16	16	AN ACT concerning 1
17	17
18	18	Pharmacy Benefits Administration – Maryland Medical Assistance Program and 2
19	19	Pharmacy Benefits Managers 3
20	20
21	21	FOR the purpose of altering the reimbursement levels for drug products that the Maryland 4
22	22	Medical Assistance Program is required to establish and that pharmacy benefits 5
23	23	managers that contract with a pharmacy on behalf of a managed care organization 6
24	24	are required to reimburse the pharmacy; altering the definition of “purchaser” for 7
25	25	purposes of certain provisions of law regulating pharmacy benefits managers to 8
26	26	include certain insurers, nonprofit health services plans, and health maintenance 9
27	27	organizations; and generally relating to pharmacy benefits administration. 10
28	28
29	29	BY repealing and reenacting, with amendments, 11
30	30	Article – Health – General 12
31	31	Section 15–118(b) 13
32	32	Annotated Code of Maryland 14
33	33	(2019 Replacement Volume and 2022 Supplement) 15
34	34
35	35	BY adding to 16
36	36	Article – Health – General 17
37	37	Section 15–118(f) 18
38	38	Annotated Code of Maryland 19
39	39	(2019 Replacement Volume and 2022 Supplement) 20
40	40
41	41	BY repealing and reenacting, with amendments, 21
42	42	Article – Insurance 22
43	43	Section 15–1601(s) 23
44	44	Annotated Code of Maryland 24
45	45	(2017 Replacement Volume and 2022 Supplement) 25
46	46
47	47	BY adding to 26
48	48	Article – Insurance 27 2 SENATE BILL 895
49	49
50	50
51	51	Section 15–1632 1
52	52	Annotated Code of Maryland 2
53	53	(2017 Replacement Volume and 2022 Supplement) 3
54	54
55	55	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 4
56	56	That the Laws of Maryland read as follows: 5
57	57
58	58	Article – Health – General 6
59	59
60	60	15–118. 7
61	61
62	62	(b) (1) [Except] SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION A ND 8
63	63	EXCEPT as provided under paragraph [(2)] (3) of this subsection, the Program shall 9
64	64	establish [maximum] reimbursement levels for the drug products for which there is a 10
65	65	generic equivalent authorized under § 12–504 of the Health Occupations Article[, based on 11
66	66	the cost of the generic product]. 12
67	67
68	68	(2) EXCEPT AS PROVIDED IN PARAGRAPH (4) OF THIS SUBSECTION , 13
69	69	MINIMUM REIMBURSEMEN T LEVELS ESTABLISHED UNDER PARAGRAPH (1) OF THIS 14
70	70	SUBSECTION SHALL BE AT LEAST EQUAL TO TH E NATIONAL AVERAGE DRUG 15
71	71	ACQUISITION COST OF THE GENERIC PRODUCT PLUS THE 16
72	72	FEE–FOR–SERVICE PROFESSIONAL DISPENSING FEE DETER MINED BY THE 17
73	73	DEPARTMENT IN ACCORDA NCE WITH THE MOST RE CENT IN –STATE 18
74	74	COST–OF–DISPENSING SURVEY . 19
75	75
76	76	[(2)] (3) [If] EXCEPT AS PROVIDED IN PARAGRAPH (4) OF THIS 20
77	77	SUBSECTION, IF a prescriber directs a specific brand name drug, the reimbursement level 21
78	78	shall be based on the [cost] NATIONAL AVERAGE DRUG ACQUISITION COST of the 22
79	79	brand name product PLUS THE FEE–FOR–SERVICE PROFESSIONAL DISPENSING FEE 23
80	80	DETERMINED BY THE DEPARTMENT IN ACCORDA NCE WITH THE MOST RECENT 24
81	81	IN–STATE COST–OF–DISPENSING SURVEY . 25
82	82
83	83	(4) PARAGRAPHS (2) AND (3) OF THIS SUBSECTION D O NOT APPLY TO: 26
84	84
85	85	(I) A PHARMACY OWNED BY , OR UNDER THE SAME CO RPORATE 27
86	86	AFFILIATION, AS A PHARMACY BENEFI TS MANAGER; OR 28
87	87
88	88	(II) A MAIL ORDER PHARMACY . 29
89	89
90	90	(F) THE PROVISIONS OF § 15–1632 OF THE INSURANCE ARTICLE APPLY TO 30
91	91	A MANAGED CARE ORGAN IZATION THAT USES A PHARMACY BENEFITS MA NAGER TO 31
92	92	MANAGE PRESCRIPTION DRUG COVERAGE BENEFI TS ON BEHALF OF THE MANAGED 32
93	93	CARE ORGANIZATION . 33
94	94
95	95	Article – Insurance 34 SENATE BILL 895 3
96	96
97	97
98	98
99	99	15–1601. 1
100	100
101	101	(s) (1) “Purchaser” means a person that offers a plan or program in the State, 2
102	102	including the State Employee and Retiree Health and Welfare Benefits Program, AN 3
103	103	INSURER, A NONPROFIT HEALTH S ERVICE PLAN , OR A HEALTH MAINTENA NCE 4
104	104	ORGANIZATION , that: 5
105	105
106	106	[(1)] (I) provides prescription drug coverage or benefits in the State; and 6
107	107
108	108	[(2)] (II) enters into an agreement with a pharmacy benefits manager for 7
109	109	the provision of pharmacy benefits management services. 8
110	110
111	111	(2) “PURCHASER” DOES NOT INCLUDE A N ONPROFIT HEALTH 9
112	112	MAINTENANCE ORGANIZA TION THAT: 10
113	113
114	114	(I) OPERATES AS A GROUP MODEL; 11
115	115
116	116	(II) PROVIDES SERVICES SO LELY TO A MEMBER OR PATIENT OF 12
117	117	THE NONPROFIT HEALTH MAINTENANCE ORGANIZA TION; AND 13
118	118
119	119	(III) FURNISHES SERVICES T HROUGH THE INTERNAL PHARMACY 14
120	120	OPERATIONS OF THE N ONPROFIT HEALTH MAIN TENANCE ORGANIZATION . 15
121	121
122	122	15–1632. 16
123	123
124	124	A PHARMACY BENEFITS MA NAGER THAT CONTRACTS WITH A PHARMACY ON 17
125	125	BEHALF OF A MANAGED CARE ORGANIZATION , AS DEFINED IN § 15–101 OF THE 18
126	126	HEALTH – GENERAL ARTICLE, SHALL REIMBURSE THE PHARMACY AN AMOUNT 19
127	127	THAT IS AT LEAST EQUAL TO THE NATIONAL AVERAGE DRUG ACQUISITION COST 20
128	128	PLUS THE FEE–FOR–SERVICE PROFESSIONAL DISPENSING FEE DETER MINED BY THE 21
129	129	MARYLAND DEPARTMENT OF HEALTH FOR THE MARYLAND MEDICAL ASSISTANCE 22
130	130	PROGRAM IN ACCORDANCE WITH THE MOST RECENT IN–STATE 23
131	131	COST–OF–DISPENSING SURVEY . 24
132	132
133	133	SECTION 2. AND BE IT FURTHER ENACTED, That this Act is an emergency 25
134	134	measure, is necessary for the immediate preservation of the public health or safety, has 26
135	135	been passed by a yea and nay vote supported by three–fifths of all the members elected to 27
136	136	each of the two Houses of the General Assembly, and shall take effect from the date it is 28
137	137	enacted. 29
138	138
139	139