Maryland 2024 Regular Session

Maryland House Bill HB879 Compare Versions

Version 1 (Old)

Version 2 (New)

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		-	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	5		hb0879
9	6
10	7		HOUSE BILL 879
11	8		J5 4lr2511
12	9		CF SB 595
13		-	By: Delegates S. Johnson and A. Johnson, A. Johnson, Alston, Bagnall, Bhandari,
14		-	Chisholm, Cullison, Guzzone, Hill, Hutchinson, Kaiser, Kipke, R. Lewis,
15		-	Lopez, Martinez, M. Morgan, Pena–Melnyk, Reilly, Rosenberg, Szeliga,
16		-	Taveras, White Holland, and Woods
	10	+	By: Delegates S. Johnson and A. Johnson
17	11		Introduced and read first time: February 2, 2024
18	12		Assigned to: Health and Government Operations
19		-	Committee Report: Favorable with amendments
20		-	House action: Adopted
21		-	Read second time: March 1, 2024
22	13
23		-	~~CHAPTER ______~~
	14	+	A BILL ENTITLED
24	15
25	16		AN ACT concerning 1
26	17
27	18		Health Benefit Plans – Calculation of Cost Sharing Contribution – 2
28	19		Requirements and Prohibitions 3
29	20
30		-	FOR the purpose of requiring certain insurers, nonprofit health service plans, and health 4
31		-	maintenance organizations to include certain discounts, financial assistance 5
32		-	payments, product vouchers, and other out–of–pocket expenses made by or on behalf 6
33		-	of an insured or enrollee when calculating certain cost–sharing contributions for 7
34		-	certain prescription drugs; requiring persons that provide certain discounts, 8
35		-	financial assistance payments, product vouchers, or other out–of–pocket expenses to 9
36		-	notify an insured or enrollee of certain information; providing that a violation of a 10
37		-	certain provision of this Act is considered a violation of the Consumer Protection Act; 11
38		-	administrators, carriers, and pharmacy benefits managers to include certain cost 12
39		-	sharing amounts paid by or on behalf of an enrollee or a beneficiary when calculating 13
40		-	the enrollee’s or beneficiary’s contribution to a cost sharing requirement; requiring 14
41		-	administrators, carriers, and pharmacy benefits managers to include certain cost 15
42		-	sharing amounts for certain high deductible health plans after an enrollee or a 16
43		-	beneficiary satisfies a certain requirement; prohibiting administrators, carriers, and 17
44		-	pharmacy benefits managers from directly or indirectly setting, altering, 18
45		-	implementing, or conditioning the terms of certain coverage based on certain 19
46		-	information; and generally relating to the calculation of cost sharing requirements. 20
	21	+	FOR the purpose of requiring administrators, carriers, and pharmacy benefits managers to 4
	22	+	include certain cost sharing amounts paid by or on behalf of an enrollee or a 5
	23	+	beneficiary when calculating the enrollee’s or beneficiary’s contribution to a cost 6
	24	+	sharing requirement; requiring administrators, carriers, and pharmacy benefits 7
	25	+	managers to include certain cost sharing amounts for certain high deductible health 8
	26	+	plans after an enrollee or a beneficiary satisfies a certain requirement; prohibiting 9
	27	+	administrators, carriers, and pharmacy benefits managers from directly or indirectly 10
	28	+	setting, altering, implementing, or conditioning the terms of certain coverage based 11
	29	+	on certain information; and generally relating to the calculation of cost sharing 12
	30	+	requirements. 13
47	31
48		-	BY adding to 21 2 HOUSE BILL 879
	32	+	BY adding to 14
	33	+	Article – Insurance 15
	34	+	Section 15–118.1 and 15–1611.3 16
	35	+	Annotated Code of Maryland 17
	36	+	(2017 Replacement Volume and 2023 Supplement) 18
49	37
	38	+	BY repealing and reenacting, with amendments, 19
	39	+	Article – Insurance 20
	40	+	Section 15–1601 21
	41	+	Annotated Code of Maryland 22
	42	+	(2017 Replacement Volume and 2023 Supplement) 23
50	43
51		-	Article – Insurance 1
52		-	Section 15–118.1 and 15–1611.3 2
53		-	Annotated Code of Maryland 3
54		-	(2017 Replacement Volume and 2023 Supplement) 4
	44	+	Preamble 24
55	45
56		-	BY repealing and reenacting, with amendments, 5
57		-	Article – Insurance 6
58		-	Section 15–1601 7
59		-	Annotated Code of Maryland 8
60		-	(2017 Replacement Volume and 2023 Supplement) 9
61		-
62		-	Preamble 10
63		-
64		-	WHEREAS, Residents of Maryland frequently rely on State–regulated commercial 11
65		-	health insurance carriers to secure access to the prescription medicines needed to protect 12
66		-	their health; and 13
67		-
68		-	WHEREAS, Commercial health insurance designs increasingly require patients to 14
69		-	bear significant out–of–pocket costs for their prescription medicines; and 15
70		-
71		-	WHEREAS, High out–of–pocket costs on prescription medicines impact the ability 16
72		-	of patients to start new and necessary medicines and to stay adherent to their current 17
73		-	prescriptions; and 18
74		-
75		-	WHEREAS, High or unpredictable cost sharing requirements are a main driver of 19
76		-	elevated patient out–of–pocket costs and allow health insurance carriers to capture 20
77		-	discounts and price concessions that are intended to benefit patients at the pharmacy 21
78		-	counter; and 22
79		-
80		-	WHEREAS, Health insurance carriers unfairly increase cost sharing burdens on 23
81		-	patients by refusing to count third–party assistance toward patients’ cost sharing 24
82		-	contributions; and 25
83		-
84		-	WHEREAS, The burdens of high or unpredictable cost sharing requirements are 26
85		-	borne disproportionately by patients with chronic or debilitating conditions; and 27
86		-
87		-	WHEREAS, Restrictions are needed on the ability of health insurance carriers and 28
88		-	their intermediaries to use unfair cost sharing designs to retain rebates and price 29
89		-	concessions that instead should be directly passed on to patients as cost savings; and 30
90		-
91		-	WHEREAS, Patients need equitable and accessible health coverage that does not 31
92		-	impose unfair cost sharing burdens on them; now, therefore, 32
93		-
94		-	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 33
95		-	That the Laws of Maryland read as follows: 34
96		-
97		-	Article – Insurance 35 HOUSE BILL 879 3
	46	+	WHEREAS, Residents of Maryland frequently rely on State–regulated commercial 25
	47	+	health insurance carriers to secure access to the prescription medicines needed to protect 26
	48	+	their health; and 27 2 HOUSE BILL 879
98	49
99	50
100	51
101		-	15–118.1. 1
	52	+	WHEREAS, Commercial health insurance designs increasingly require patients to 1
	53	+	bear significant out–of–pocket costs for their prescription medicines; and 2
102	54
103		-	(A) (1) THIS SECTION APPLIES TO: 2
	55	+	WHEREAS, High out–of–pocket costs on prescription medicines impact the ability 3
	56	+	of patients to start new and necessary medicines and to stay adherent to their current 4
	57	+	prescriptions; and 5
104	58
105		-	~~(I) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 3~~
106		-	~~PROVIDE HOSPITAL , MEDICAL,~~ ~~OR SURGICAL BENEFITS~~ TO ~~INDIVIDUALS OR GR OUPS 4~~
107		-	~~ON AN EXPENSE –INCURRED~~ ~~BASIS UNDER HEALTH INSURANCE POL ICIES OR 5~~
108		-	~~CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE~~; AND 6
	59	+	WHEREAS, High or unpredictable cost sharing requirements are a main driver of 6
	60	+	elevated patient out–of–pocket costs and allow health insurance carriers to capture 7
	61	+	discounts and price concessions that are intended to benefit patients at the pharmacy 8
	62	+	counter; and 9
109	63
110		-	~~(II)~~ HEALTH ~~MAINTENANCE O RGANIZATIONS THAT PR OVIDE 7~~
111		-	~~HOSPITAL, MEDICAL,~~ ~~OR SURGICAL BENEFITS~~ TO ~~INDIVIDUALS OR GR OUPS UNDER 8~~
112		-	~~CONTRACTS THAT ARE I SSUED OR DELIVERED I N THE STATE. 9~~
	64	+	WHEREAS, Health insurance carriers unfairly increase cost sharing burdens on 10
	65	+	patients by refusing to count third–party assistance toward patients’ cost sharing 11
	66	+	contributions; and 12
113	67
114		-	(2) AN INSURER, A NONPROFIT HEALTH S ERVICE PLAN, OR A HEALTH 10
115		-	MAINTENANCE ORGANIZA TION THAT PROVIDES C OVERAGE FOR PRESCRIP TION 11
116		-	DRUGS THR OUGH A PHARMACY BENE FITS MANAGER IS SUBJ ECT TO THE 12
117		-	REQUIREMENTS OF THIS SECTION. 13
	68	+	WHEREAS, The burdens of high or unpredictable cost sharing requirements are 13
	69	+	borne disproportionately by patients with chronic or debilitating conditions; and 14
118	70
119		-	(B) (1) SUBJECT TO PARAGRAPH (2) OF THIS SUBSECTION , WHEN 14
120		-	CALCULATING AN INSUR ED’S OR ENROLLEE ’S CONTRIBUTION TO TH E INSURED’S OR 15
121		-	ENROLLEE’S COINSURANCE , COPAYMENT , DEDUCTIBLE, OR OUT–OF–POCKET 16
122		-	MAXIMUM UNDER THE IN SURED’S OR ENROLLEE ’S HEALTH BENEFIT PLA N, AN 17
123		-	ENTITY SUBJECT TO TH IS SECTION SHALL INC LUDE ANY DISCOUNT , FINANCIAL 18
124		-	ASSISTANCE PAYMENT , PRODUCT VOUCHER , OR OTHER OUT –OF–POCKET EXPENSE 19
125		-	MADE BY OR ON BEHALF OF THE INSU RED OR ENROLLEE FOR A PRESCRIPTION 20
126		-	DRUG: 21
	71	+	WHEREAS, Restrictions are needed on the ability of health insurance carriers and 15
	72	+	their intermediaries to use unfair cost sharing designs to retain rebates and price 16
	73	+	concessions that instead should be directly passed on to patients as cost savings; and 17
127	74
128		-	~~(I)~~ THAT ~~IS COVERED UNDE R THE INSURED ’S OR ENROLLEE ’S 22~~
129		-	~~HEALTH BENEFIT PLAN~~ ; ~~AND 23~~
	75	+	WHEREAS, Patients need equitable and accessible health coverage that does not 18
	76	+	impose unfair cost sharing burdens on them; now, therefore, 19
130	77
131		-	(II) 1. THAT DOES NOT HAVE A N AB–RATED GENERIC 24
132		-	EQUIVALENT DRUG OR A N INTERCHANGEABLE BI OLOGICAL PRODUCT PRE FERRED 25
133		-	UNDER THE HEALTH BENEFIT PLAN ’S FORMULARY ; OR 26
	78	+	SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 20
	79	+	That the Laws of Maryland read as follows: 21
134	80
135		-	2. A. THAT HAS AN AB–RATED GENERIC 27
136		-	EQUIVALENT DRUG OR A N INTERCHANGEABLE BI OLOGICAL PRODUCT PRE FERRED 28
137		-	UNDER THE HEALTH BEN EFIT PLAN’S FORMULARY ; AND 29
	81	+	Article – Insurance 22
138	82
139		-	B. FOR WHICH THE INSURE D OR ENROLLEE ORIGIN ALLY 30
140		-	OBTAINED COVE RAGE THROUGH PRIOR A UTHORIZATION , A STEP THERAPY 31
141		-	PROTOCOL, OR THE EXCEPTION OR APPEAL PROCESS OF TH E ENTITY SUBJECT TO 32
142		-	THIS SECTION. 33
	83	+	15–118.1. 23
	84	+
	85	+	(A) (1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 24
	86	+	INDICATED. 25
	87	+
	88	+	(2) “ADMINISTRATOR ” HAS THE MEANING STAT ED IN § 8–301 OF THIS 26
	89	+	ARTICLE. 27
	90	+
	91	+	(3) “CARRIER” MEANS AN ENTITY SUBJ ECT TO THE JURISDICT ION OF 28
	92	+	THE COMMISSIONER THAT CON TRACTS, OR OFFERS TO CONTRAC T, TO PROVIDE, 29
	93	+	DELIVER, ARRANGE FOR , PAY FOR, OR REIMBURSE ANY OF THE COSTS OF HEALTH 30
	94	+	CARE SERVICES UNDER A HEALTH BENEFIT PLA N IN THE STATE. 31
	95	+	HOUSE BILL 879 3
	96	+
	97	+
	98	+	(4) “COST SHARING ” MEANS ANY COPAYMENT , COINSURANCE , 1
	99	+	DEDUCTIBLE, OR OTHER SIMILAR CHA RGE REQUIRED OF AN E NROLLEE FOR A 2
	100	+	HEALTH CARE SERVICE COVERED BY A HEALTH BENEFIT PLAN , INCLUDING A 3
	101	+	PRESCRIPTION DRUG , AND PAID BY OR ON BE HALF OF THE ENROLLEE . 4
	102	+
	103	+	(5) “ENROLLEE” MEANS AN INDIVIDUAL ENTITLED TO PAYMENT FOR 5
	104	+	HEALTH CARE SERVICES FROM AN ADMINISTRATO R OR A CARRIER. 6
	105	+
	106	+	(6) “HEALTH BENEFIT PLAN ” MEANS A POLICY , A CONTRACT , A 7
	107	+	CERTIFICATION , OR AN AGREEMENT OFFE RED OR ISSUED BY AN ADMINISTRATOR 8
	108	+	OR A CARRIER TO PROVIDE , DELIVER, ARRANGE FOR , PAY FOR, OR REIMBURSE ANY 9
	109	+	OF THE COSTS OF HEAL TH CARE SERVICES . 10
	110	+
	111	+	(7) “HEALTH CARE SERVICE ” MEANS AN ITEM OR SER VICE PROVIDED 11
	112	+	TO AN INDIVIDUAL FOR THE PURPOSE OF PREVE NTING, ALLEVIATING, CURING, OR 12
	113	+	HEALING HUMAN I LLNESS, INJURY, OR PHYSICAL DISABILI TY. 13
	114	+
	115	+	(B) THE ANNUAL LIMITATION ON COST SHARING PROV IDED FOR UNDER 42 14
	116	+	U.S.C. § 18022(C)(1) SHALL APPLY TO ALL H EALTH CARE SERVICES COVERED 15
	117	+	UNDER A HEALTH BENEF IT PLAN OFFERED OR I SSUED BY AN ADMINIST RATOR OR A 16
	118	+	CARRIER IN THE STATE. 17
	119	+
	120	+	(C) (1) SUBJECT TO PARAGRAPHS (2) AND (3) OF THIS SUBSECTION , 18
	121	+	WHEN CALCULATING AN ENROLLEE’S CONTRIBUTION TO AN APPLICABLE COST 19
	122	+	SHARING REQUIREMENT , AN ADMINISTRATOR OR A CARRIER SHALL INCL UDE COST 20
	123	+	SHARING AMOUNTS PAID BY THE ENROLLEE OR O N BEHALF OF THE ENRO LLEE BY 21
	124	+	ANOTHER PERSON . 22
	125	+
	126	+	(2) IF THE APPLICATION OF THE REQUIREMENT UNDE R PARAGRAPH 23
	127	+	(1) OF THIS SUBSECTION W OULD RESULT IN HEALT H SAVINGS ACCOUNT 24
	128	+	INELIGIBILITY UNDER § 223 OF THE INTERNAL REVENUE CODE, THE REQUIREMENT 25
	129	+	SHALL APPLY TO HEALT H SAVINGS ACCOUNT –QUALIFIED HIGH DEDUCTIB LE 26
	130	+	HEALTH PLANS WITH RE SPECT TO THE DEDUCTI BLE OF THE PLAN AFTE R THE 27
	131	+	ENROLLEE SATISFIES T HE MINIMUM DEDUCTIBL E UNDER § 223 OF THE INTERNAL 28
	132	+	REVENUE CODE. 29
	133	+
	134	+	(3) FOR ITEMS OR SERVICES THAT ARE PREVENTIVE CARE IN 30
	135	+	ACCORDANCE WITH § 223(C)(2)(C) OF THE INTERNAL REVENUE CODE, THE 31
	136	+	REQUIREMENTS OF THIS SUBSECTION SHALL APP LY REGARDLESS OF WHE THER THE 32
	137	+	ENROLLEE SATISFIES T HE MINIMUM DEDUCTIBL E UNDER § 223 OF THE INTERNAL 33
	138	+	REVENUE CODE. 34
143	139		4 HOUSE BILL 879
144	140
145	141
146		-	(2) IF AN INSURED OR ENRO LLEE IS COVERED UNDE R A 1
147		-	HIGH–DEDUCTIBLE HEALTH PL AN, AS DEFINED IN 26 U.S.C. § 223, THIS 2
148		-	SUBSECTION DOES NOT APPL Y TO THE DEDUCTIBLE REQUIREMENT OF THE 3
149		-	HIGH–DEDUCTIBLE HEALTH PL AN. 4
	142	+	(D) AN ADMINISTRATOR OR A CARRIER MAY NOT DIRECTLY OR INDIRECTLY 1
	143	+	SET, ALTER, IMPLEMENT, OR CONDITION THE TER MS OF HEALTH BENEFIT PLAN 2
	144	+	COVERAGE, INCLUDING THE BENEFI T DESIGN, BASED IN WHOLE OR IN PART ON 3
	145	+	INFORMATION ABOUT TH E AVAILABILITY OR AM OUNT OF FINANCIAL OR PRODUCT 4
	146	+	ASSISTANCE AVAILABLE FOR A PRESCRIPTION D RUG. 5
150	147
151		-	(C) (1) A PERSON THAT PROVIDES A DISCOUNT, FINANCIAL ASSISTANCE 5
152		-	PAYMENT, PRODUCT VOUCHER , OR OTHER OUT –OF–POCKET EXPENSE MADE BY OR 6
153		-	ON BEHALF OF THE INS URED OR ENROL LEE THAT IS USED IN THE CALCULATION OF 7
154		-	THE INSURED’S OR ENROLLEE ’S CONTRIBUTION TO TH E INSURED’S OR ENROLLEE ’S 8
155		-	COINSURANCE , COPAYMENT , DEDUCTIBLE, OR OUT–OF–POCKET MAXIMUM SHALL 9
156		-	NOTIFY THE INSURED O R ENROLLEE OF : 10
	148	+	(E) THE COMMISSIONER MAY ADOP T REGULATIONS TO CAR RY OUT THIS 6
	149	+	SECTION. 7
157	150
158		-	(I) THE MAXIMUM DOLLAR A MOUNT OF THE DI SCOUNT, 11
159		-	FINANCIAL ASSISTANCE PAYMENT, PRODUCT VOUCHER , OR OTHER 12
160		-	OUT–OF–POCKET EXPENSE ; AND 13
	151	+	15–1601. 8
161	152
162		-	(II) THE EXPIRATION DATE FOR THE DISCOUNT , FINANCIAL 14
163		-	ASSISTANCE PAYMENT , PRODUCT VOUCHER , OR OTHER OUT –OF–POCKET EXPENSE . 15
	153	+	(a) In this subtitle the following words have the meanings indicated. 9
164	154
165		-	(2) A ~~VIOLATION OF PARAGRA PH (1) OF THIS SUBSECTION IS~~ A 16
166		-	~~VIOLATION~~ OF ~~THE CONSUMER PROTECTION ACT~~. 17
	155	+	(b) “Agent” means a pharmacy, a pharmacist, a mail order pharmacy, or a 10
	156	+	nonresident pharmacy acting on behalf or at the direction of a pharmacy benefits manager. 11
167	157
168		-	(A) ~~(1) IN THIS SECTION THE F OLLOWING WORDS HAVE THE MEANINGS 18~~
169		-	~~INDICATED~~. 19
	158	+	(c) “Beneficiary” means an individual who receives prescription drug coverage or 12
	159	+	benefits from a purchaser. 13
170	160
171		-	(2) “ADMINISTRATOR ” HAS THE MEANING STAT ED IN § 8–301 OF THIS 20
172		-	ARTICLE. 21
	161	+	(d) (1) “Carrier” means the State Employee and Retiree Health and Welfare 14
	162	+	Benefits Program, an insurer, a nonprofit health service plan, [or] a health maintenance 15
	163	+	organization, OR ANY OTHER ENTITY SUBJECT TO THE JURIS DICTION OF THE 16
	164	+	COMMISSIONER that: 17
173	165
174		-	(3) “CARRIER” MEANS AN ENTITY SUBJ ECT TO THE JURISDICTION OF 22
175		-	THE COMMISSIONER THAT CON TRACTS, OR OFFERS TO CONTRAC T, TO PROVIDE, 23
176		-	DELIVER, ARRANGE FOR , PAY FOR, OR REIMBURSE ANY OF THE COSTS OF HEALTH 24
177		-	CARE SERVICES UNDER A HEALTH BENEFIT PLA N IN THE STATE. 25
	166	+	(i) provides prescription drug coverage or benefits in the State; and 18
178	167
179		-	(4) “COST SHARING ” MEANS ANY COPAYM ENT, COINSURANCE , 26
180		-	DEDUCTIBLE, OR OTHER SIMILAR CHA RGE REQUIRED OF AN E NROLLEE FOR A 27
181		-	HEALTH CARE SERVICE COVERED BY A HEALTH BENEFIT PLAN , INCLUDING A 28
182		-	PRESCRIPTION DRUG , AND PAID BY OR ON BE HALF OF THE ENROLLEE . 29
	168	+	(ii) enters into an agreement with a pharmacy benefits manager for 19
	169	+	the provision of pharmacy benefits management services. 20
183	170
184		-	(5) “ENROLLEE” MEANS AN INDIVIDUAL ENTITLED TO PAYMENT FOR 30
185		-	HEALTH CARE SERVICES FROM AN ADMINISTRATO R OR A CARRIER. 31
	171	+	(2) “Carrier” does not include a person that provides prescription drug 21
	172	+	coverage or benefits through plans subject to ERISA and does not provide prescription drug 22
	173	+	coverage or benefits through insurance, unless the person is a multiple employer welfare 23
	174	+	arrangement as defined in § 514(b)(6)(a)(ii) of ERISA. 24
186	175
187		-	(6) “HEALTH BENEFIT PLAN ” MEANS A POLICY , A CONTRACT , A 32
188		-	CERTIFICATION , OR AN AGREEMENT OFFE RED OR ISSUED BY AN ADMINISTRATOR 33 HOUSE BILL 879 5
	176	+	(e) “Compensation program” means a program, policy, or process through which 25
	177	+	sources and pricing information are used by a pharmacy benefits manager to determine the 26
	178	+	terms of payment as stated in a participating pharmacy contract. 27
	179	+
	180	+	(f) “Contracted pharmacy” means a pharmacy that participates in the network of 28
	181	+	a pharmacy benefits manager through a contract with: 29
	182	+
	183	+	(1) the pharmacy benefits manager; or 30
	184	+
	185	+	(2) a pharmacy services administration organization or a group purchasing 31
	186	+	organization. 32
	187	+	HOUSE BILL 879 5
189	188
190	189
191		-	OR A CARRIER TO PROV IDE, DELIVER, ARRANGE FOR , PAY FOR, OR REIMBURSE ANY 1
192		-	OF THE COSTS OF HEAL TH CARE SERVICES . 2
	190	+	(G) “COST SHARING ” MEANS ANY COPAYMENT , COINSURANCE , 1
	191	+	DEDUCTIBLE, OR OTHER SIMILAR CHA RGE REQUIRED OF A BENEFICIARY FOR A 2
	192	+	HEALTH CARE SERVICE COVERED BY A HEALTH BENEFIT PLAN , INCLUDING A 3
	193	+	PRESCRIPTION DRUG , AND PAID BY OR ON BE HALF OF THE BENEFICI ARY. 4
193	194
194		-	(7) “HEALTH CARE SERVICE ” MEANS AN ITEM OR SER VICE PROVIDED 3
195		-	TO AN INDIVIDUAL FOR THE PURPOSE OF PREVE NTING, ALLEVIATING, CURING, OR 4
196		-	HEALING HUMAN ILLNES S, INJURY, OR PHYSICAL DISABILI TY. 5
	195	+	[(g)] (H) “ERISA” has the meaning stated in § 8–301 of this article. 5
197	196
198		-	(B) THE ANNUAL LIMITATION ON COST SHARING PROVIDE D FOR UNDER 42 6
199		-	U.S.C. § 18022(C)(1) SHALL APPLY TO ALL H EALTH CARE SERVICES COVERED 7
200		-	UNDER A HEALTH BENEF IT PLAN OFFERED OR I SSUED BY AN ADMINIST RATOR OR A 8
201		-	CARRIER IN THE STATE. 9
	197	+	[(h)] (I) “Formulary” means a list of prescription drugs used by a purchaser. 6
202	198
203		-	(C) (1) SUBJECT TO PARAGRAPHS (2) AND (3) OF THIS SUBSECTION , 10
204		-	WHEN CALCULATING AN ENROLLEE’S CONTRIBUTION TO AN APPLICABLE COST 11
205		-	SHARING REQUIREMENT , AN ADMINISTRATOR OR A CARRIER SHALL INCL UDE COST 12
206		-	SHARING AMOUNTS PAID BY THE ENROLLEE OR O N BEHALF OF THE ENRO LLEE BY 13
207		-	ANOTHER PERSON . 14
	199	+	(J) “HEALTH BENEFIT PLAN ” MEANS A POLICY , A CONTRACT , A 7
	200	+	CERTIFICATION , OR AN AGREEMENT OFFE RED OR ISSUED BY AN ADMINISTRATOR 8
	201	+	OR A CARRIER TO PROV IDE, DELIVER, ARRANGE FOR , PAY FOR, OR REIMBURSE ANY 9
	202	+	PORTION OF THE COST OF HEALT H CARE SERVICES . 10
208	203
209		-	(2) IF THE APPLICATION OF THE REQUIREMENT UNDE R PARAGRAPH 15
210		-	(1) OF THIS SUBSECTION W OULD RESULT IN HEALT H SAVINGS ACCOUNT 16
211		-	INELIGIBILITY UNDER § 223 OF THE INTERNAL REVENUE CODE, THE REQUIREMENT 17
212		-	SHALL APPLY TO HEALT H SAVINGS ACCOUNT –QUALIFIED HIGH DEDUC TIBLE 18
213		-	HEALTH PLANS WITH RESPE CT TO THE DEDUCTIBLE OF THE PLAN AFTER TH E 19
214		-	ENROLLEE SATISFIES T HE MINIMUM DEDUCTIBL E UNDER § 223 OF THE INTERNAL 20
215		-	REVENUE CODE. 21
	204	+	(K) “HEALTH CARE SERVICE ” MEANS AN ITEM OR SER VICE PROVIDED TO AN 11
	205	+	INDIVIDUAL FOR THE P URPOSE OF PREVENTING , ALLEVIATING, CURING, OR 12
	206	+	HEALING HUMAN ILLNES S, INJURY, OR PHYSICAL DISABILI TY. 13
216	207
217		-	(3) FOR ITEMS OR SERVICES THAT ARE PREVENTIVE CARE IN 22
218		-	ACCORDANCE WITH § 223(C)(2)(C) OF THE INTERNAL REVENUE CODE, THE 23
219		-	REQUIREMENTS OF THIS SUBSECTION SHALL APP LY REGARDLESS OF WHE THER THE 24
220		-	ENROLLEE SATISFIES T HE MINIMUM DEDUCTIBL E UNDER § 223 OF THE INTERNAL 25
221		-	REVENUE CODE. 26
	208	+	[(i)] (L) (1) “Manufacturer payments” means any compensation or 14
	209	+	remuneration a pharmacy benefits manager receives from or on behalf of a pharmaceutical 15
	210	+	manufacturer. 16
222	211
223		-	(D) AN ADMINISTRATOR OR A CARRIER MAY NOT DIRE CTLY OR INDIRECTLY 27
224		-	SET, ALTER, IMPLEMENT, OR CONDITION THE TER MS OF HEALTH BENEFIT PLAN 28
225		-	COVERAGE, INCLUDING THE BENEFI T DESIGN, BASED IN WHOLE OR IN PART ON 29
226		-	INFORMATION ABOUT TH E AVAILABILITY OR AM OUNT OF FINANCIAL OR PRODUCT 30
227		-	ASSISTANCE AVAILABLE FOR A PRESCRIPTION D RUG. 31
	212	+	(2) “Manufacturer payments” includes: 17
228	213
229		-	(E) ~~THE COMMISSION ER MAY ADOPT REGULAT IONS TO CARRY OUT TH IS 32~~
230		-	~~SECTION. 33~~
	214	+	(i) payments received in accordance with agreements with 18
	215	+	pharmaceutical manufacturers for formulary placement and, if applicable, drug utilization; 19
231	216
232		-	15–1601. 34
	217	+	(ii) rebates, regardless of how categorized; 20
	218	+
	219	+	(iii) market share incentives; 21
	220	+
	221	+	(iv) commissions; 22
	222	+
	223	+	(v) fees under products and services agreements; 23
	224	+
	225	+	(vi) any fees received for the sale of utilization data to a 24
	226	+	pharmaceutical manufacturer; and 25
	227	+
	228	+	(vii) administrative or management fees. 26
	229	+
	230	+	(3) “Manufacturer payments” does not include purchase discounts based on 27
	231	+	invoiced purchase terms. 28
	232	+
	233	+	[(j)] (M) “Nonprofit health maintenance organization” has the meaning stated 29
	234	+	in § 6–121(a) of this article. 30
233	235		6 HOUSE BILL 879
234	236
235	237
236		-	(a) In this subtitle the following words have the meanings indicated. 1
	238	+	[(k)] (N) “Nonresident pharmacy” has the meaning stated in § 12–403 of the 1
	239	+	Health Occupations Article. 2
237	240
238		-	(b) “~~Agent~~” means a ~~pharmacy, a pharmacist,~~ ~~a mail order pharmacy, or a 2~~
239		-	~~nonresident pharmacy acting on behalf or at the direction~~ of ~~a pharmacy benefits manager~~. 3
	241	+	[(l)] (O) “Participating pharmacy contract” means a contract filed with the 3
	242	+	Commissioner in accordance with § 15–1628(b) of this subtitle. 4
240	243
241		-	(c) “~~Beneficiary~~” ~~means an individual who receives prescription drug coverage or 4~~
242		-	~~benefits from a purchaser~~. 5
	244	+	[(m)] (P) “Pharmacist” has the meaning stated in § 12–101 of the Health 5
	245	+	Occupations Article. 6
243	246
244		-	(d) (1) “Carrier” means the State Employee and Retiree Health and Welfare 6
245		-	Benefits Program, an insurer, a nonprofit health service plan, [or] a health maintenance 7
246		-	organization, OR ANY OTHER ENTITY SUBJECT TO THE JURIS DICTION OF THE 8
247		-	COMMISSIONER that: 9
	247	+	[(n)] (Q) “Pharmacy” has the meaning stated in § 12 –101 of the Health 7
	248	+	Occupations Article. 8
248	249
249		-	(i) provides prescription drug coverage or benefits in the State; and 10
	250	+	[(o)] (R) “Pharmacy and therapeutics committee” means a committee 9
	251	+	established by a pharmacy benefits manager to: 10
250	252
251		-	(ii) enters into an agreement with a pharmacy benefits manager for 11
252		-	the provision of pharmacy benefits management services. 12
	253	+	(1) objectively appraise and evaluate prescription drugs; and 11
253	254
254		-	(2) “Carrier” does not include a person that provides prescription drug 13
255		-	coverage or benefits through plans subject to ERISA and does not provide prescription drug 14
256		-	coverage or benefits through insurance, unless the person is a multiple employer welfare 15
257		-	arrangement as defined in § 514(b)(6)(a)(ii) of ERISA. 16
	255	+	(2) make recommendations to a purchaser regarding the selection of drugs 12
	256	+	for the purchaser’s formulary. 13
258	257
259		-	(e) “Compensation program” means a program, policy, or process through which 17
260		-	sources and pricing information are used by a pharmacy benefits manager to determine the 18
261		-	terms of payment as stated in a participating pharmacy contract. 19
	258	+	[(p)] (S) (1) “Pharmacy benefits management services” means: 14
262	259
263		-	(f) “Contracted pharmacy” means a pharmacy that participates in the network of 20
264		-	a pharmacy benefits manager through a contract with: 21
	260	+	(i) the [procurement of prescription drugs at a negotiated rate for 15
	261	+	dispensation within the State to beneficiaries] NEGOTIATION OF THE P RICE OF 16
	262	+	PRESCRIPTION DRUGS , INCLUDING THE NEGOTI ATING AND CONTRACTIN G FOR 17
	263	+	DIRECT AND INDIRECT REBATES, DISCOUNTS, OR OTHER PRICE CONCE SSIONS; 18
265	264
266		-	(1) the pharmacy benefits manager; or 22
	265	+	(ii) the administration or management of prescription drug coverage 19
	266	+	provided by a purchaser for beneficiaries; [and] 20
267	267
268		-	(2) ~~a pharmacy~~ services ~~administration organization or a group purchasing 23~~
269		-	~~organization. 24~~
	268	+	(iii) any of the following services provided with regard to the 21
	269	+	administration of prescription drug coverage: 22
270	270
271		-	(G) “COST SHARING ” MEANS ANY COPAYMENT , COINSURANCE , 25
272		-	DEDUCTIBLE, OR OTHER SIMILAR CHA RGE REQUIRED OF A BE NEFICIARY FOR A 26
273		-	HEALTH CARE SERVICE COVERED BY A HEALTH BENEFIT PLAN , INCLUDING A 27
274		-	PRESCRIPTION DRUG , AND PAID BY OR ON BE HALF OF THE BENEFICI ARY. 28
	271	+	1. mail service pharmacy; 23
275	272
276		-	[(g)] (H) “ERISA” has the meaning stated in § 8–301 of this article. 29
	273	+	2. claims processing, retail network management, and 24
	274	+	payment of claims to pharmacies for prescription drugs dispensed to beneficiaries; 25
277	275
278		-	~~[(h)] (I) “Formulary” means a list of prescription drugs used by a purchaser~~. 30
	276	+	3. clinical formulary development and management services; 26
279	277
280		-	(J) “HEALTH BENEFIT PLAN ” MEANS A POLICY , A CONTRACT , A 31
281		-	CERTIFICATION , OR AN AGREEMENT OFFE RED OR ISSUED BY AN ADMINISTRATOR 32 HOUSE BILL 879 7
	278	+	4. rebate contracting and administration; 27
	279	+
	280	+	5. patient compliance, therapeutic intervention, and generic 28
	281	+	substitution programs; [or] 29
	282	+
	283	+	6. disease management programs; 30 HOUSE BILL 879 7
282	284
283	285
284		-	OR A CARRIER TO PROV IDE, DELIVER, ARRANGE FOR , PAY FOR, OR REIMBURSE ANY 1
285		-	PORTION OF THE COST OF HEALTH CARE SERVICES . 2
286	286
287		-	(K) “HEALTH CARE SERVICE ” MEANS AN ITEM OR SER VICE PROVIDED TO AN 3
288		-	INDIVIDUAL FOR THE P URPOSE OF PREVENTING , ALLEVIATING, CURING, OR 4
289		-	HEALING HUMAN ILLNES S, INJURY, OR PHYSICAL DISABILI TY. 5
	287	+	7. DRUG UTILIZATION REV IEW; OR 1
290	288
291		-	[(i)] (L) (1) “Manufacturer payments” means any compensation or 6
292		-	remuneration a pharmacy benefits manager receives from or on behalf of a pharmaceutical 7
293		-	manufacturer. 8
	289	+	8. ADJUDICATION OF APPE ALS OR GRIEVANCES 2
	290	+	RELATED TO A PRESCRI PTION DRUG BENEFIT ; 3
294	291
295		-	(2) “Manufacturer payments” includes: 9
	292	+	(IV) THE PERFORMANCE OF A DMINISTRATIVE , MANAGERIAL , 4
	293	+	CLINICAL, PRICING, FINANCIAL, REIMBURSEMENT , DATA ADMINISTRATION OR 5
	294	+	REPORTING, OR BILLING SERVICES ; OR 6
296	295
297		-	(i) ~~payments received~~ in ~~accordance with agreements with 10~~
298		-	~~pharmaceutical manufacturers for formulary placement and, if applicable, drug utilization; 11~~
	296	+	(V) OTHER SERVICES DEFIN ED BY THE COMMISSIONER IN 7
	297	+	REGULATION . 8
299	298
300		-	(ii) rebates, regardless of how categorized; 12
	299	+	(2) “Pharmacy benefits management services” does not include any service 9
	300	+	provided by a nonprofit health maintenance organization that operates as a group model, 10
	301	+	provided that the service: 11
301	302
302		-	(iii) market share incentives; 13
	303	+	(i) is provided solely to a member of the nonprofit health 12
	304	+	maintenance organization; and 13
303	305
304		-	(iv) commissions; 14
	306	+	(ii) is furnished through the internal pharmacy operations of the 14
	307	+	nonprofit health maintenance organization. 15
305	308
306		-	(v) ~~fees under products and services agreements;~~ 15
	309	+	[(q)] (T) “Pharmacy benefits manager” means: 16
307	310
308		-	(vi) any fees received for the sale of utilization data to a 16
309		-	pharmaceutical manufacturer; and 17
	311	+	(1) a person that [performs], IN ACCORDANCE WITH A WRITTEN 17
	312	+	AGREEMENT WITH A PUR CHASER, EITHER DIRECTLY OR I NDIRECTLY, PROVIDES 18
	313	+	ONE OR MORE pharmacy benefits management services; OR 19
310	314
311		-	(vii) administrative or management fees. 18
	315	+	(2) AN AGENT OR OTHER PR OXY OR REPRESENTATIV E, CONTRACTOR , 20
	316	+	INTERMEDIARY , AFFILIATE, SUBSIDIARY, OR RELATED ENTITY OF A PERSON THAT 21
	317	+	FACILITATES, PROVIDES, DIRECTS, OR OVERSEES THE PROV ISION OF PHARMACY 22
	318	+	BENEFITS MANAGEMENT SERVICES. 23
312	319
313		-	(3) “Manufacturer payments” does not include purchase discounts based on 19
314		-	invoiced purchase terms. 20
	320	+	[(r)] (U) “Proprietary information” means: 24
315	321
316		-	[(j)] (M) “Nonprofit health maintenance organization” has the meaning stated 21
317		-	in § 6–121(a) of this article. 22
	322	+	(1) a trade secret; 25
318	323
319		-	[(k)] (N) “Nonresident pharmacy” has the meaning stated in § 12–403 of the 23
320		-	Health Occupations Article. 24
	324	+	(2) confidential commercial information; or 26
321	325
322		-	[(l)] (O) “Participating pharmacy contract” means a contract filed with the 25
323		-	Commissioner in accordance with § 15–1628(b) of this subtitle. 26
	326	+	(3) confidential financial information. 27
324	327
325		-	[(m)] (P) “~~Pharmacist~~” ~~has~~ the ~~meaning stated in § 12–101 of the Health 27~~
326		-	~~Occupations Article.~~ 28
	328	+	[(s)] (V) “Purchaser” means a person that offers a plan or program in the State, 28
	329	+	including the State Employee and Retiree Health and Welfare Benefits Program, that: 29
327	330		8 HOUSE BILL 879
328	331
329	332
330		-	[(n)] (Q) “Pharmacy” has the meaning stated in § 12 –101 of the Health 1
331		-	Occupations Article. 2
	333	+	(1) provides prescription drug coverage or benefits in the State; and 1
332	334
333		-	~~[(o)]~~ (R) ~~“Pharmacy and therapeutics committee”~~ ~~means~~ a ~~committee 3~~
334		-	~~established by a~~ pharmacy benefits ~~manager to:~~ 4
	335	+	(2) enters into an agreement with a pharmacy benefits manager for the 2
	336	+	provision of pharmacy benefits management services. 3
335	337
336		-	(1) objectively appraise and evaluate prescription drugs; and 5
	338	+	[(t)] (W) “Rebate sharing contract” means a contract between a pharmacy 4
	339	+	benefits manager and a purchaser under which the pharmacy benefits manager agrees to 5
	340	+	share manufacturer payments with the purchaser. 6
337	341
338		-	(2) ~~make recommendations to a purchaser regarding the selection of drugs 6~~
339		-	~~for the purchaser’s formulary~~. 7
	342	+	[(u)] (X) (1) “Therapeutic interchange” means any change from one 7
	343	+	prescription drug to another. 8
340	344
341		-	~~[(p)]~~ (~~S) (1~~) “~~Pharmacy benefits management services~~” ~~means~~: 8
	345	+	(2) “Therapeutic interchange” does not include: 9
342	346
343		-	(i) the [procurement of prescription drugs at a negotiated rate for 9
344		-	dispensation within the State to beneficiaries] NEGOTIATION OF THE P RICE OF 10
345		-	PRESCRIPTION DRUGS , INCLUDING THE NEGOTIAT ING AND CONTRACTING FOR 11
346		-	DIRECT AND INDIRECT REBATES, DISCOUNTS, OR OTHER PRICE CONCE SSIONS; 12
	347	+	(i) a change initiated pursuant to a drug utilization review; 10
347	348
348		-	(ii) the administration or management of prescription drug coverage 13
349		-	provided by a purchaser for beneficiaries; [and] 14
	349	+	(ii) a change initiated for patient safety reasons; 11
350	350
351		-	(iii) ~~any~~ of the ~~following services provided with regard to the 15~~
352		-	~~administration of prescription~~ drug ~~coverage:~~ 16
	351	+	(iii) a change required due to market unavailability of the currently 12
	352	+	prescribed drug; 13
353	353
354		-	1. mail service pharmacy; 17
	354	+	(iv) a change from a brand name drug to a generic drug in accordance 14
	355	+	with § 12–504 of the Health Occupations Article; or 15
355	356
356		-	~~2. claims processing,~~ ~~retail network management,~~ ~~and 18~~
357		-	~~payment of claims to pharmacies for prescription drugs dispensed to beneficiaries;~~ 19
	357	+	(v) a change required for coverage reasons because the originally 16
	358	+	prescribed drug is not covered by the beneficiary’s formulary or plan. 17
358	359
359		-	3. clinical formulary development and management services; 20
	360	+	[(v)] (Y) “Therapeutic interchange solicitation” means any communication by a 18
	361	+	pharmacy benefits manager for the purpose of requesting a therapeutic interchange. 19
360	362
361		-	4. rebate contracting and administration; 21
	363	+	[(w)] (Z) “Trade secret” has the meaning stated in § 11–1201 of the Commercial 20
	364	+	Law Article. 21
362	365
363		-	5. patient compliance, therapeutic intervention, and generic 22
364		-	substitution programs; [or] 23
	366	+	15–1611.3. 22
365	367
366		-	6. disease management programs; 24
	368	+	(A) THIS SECTION APPLIES ONLY TO A PHARMACY B ENEFITS MANAGER 23
	369	+	THAT PROVIDES PHARMA CY BENEFITS MANAGEME NT SERVICES ON BEHAL F OF A 24
	370	+	CARRIER. 25
367	371
368		-	7. DRUG UTILIZATION REV IEW; OR 25
369		-
370		-	8. ADJUDICATION OF APPE ALS OR GRIEVANCES 26
371		-	RELATED TO A PRESCRI PTION DRUG BENEFIT ; 27
	372	+	(B) (1) SUBJECT TO PARAGRAPHS (2) AND (3) OF THIS SUBSECTION , 26
	373	+	WHEN CALCULATING A B ENEFICIARY’S CONTRIBUTION TO AN APPLICABLE COST 27
	374	+	SHARING REQUIREMENT , A PHARMACY BENEFITS MANAGER SHALL INCLUD E COST 28
	375	+	SHARING AMOUNTS PAID BY THE BENEFICIARY O N BEHALF OF THE BENE FICIARY BY 29
	376	+	ANOTHER PERSON . 30
372	377		HOUSE BILL 879 9
373	378
374	379
375		-	(IV) THE PERFORMANCE OF A DMINISTRATIVE , MANAGERIAL , 1
376		-	CLINICAL, PRICING, FINANCIAL, REIMBURSEMENT , DATA ADMINISTRATION OR 2
377		-	REPORTING, OR BILLING SERVICES; OR 3
378		-
379		-	(V) OTHER SERVICES DEFIN ED BY THE COMMISSIONER IN 4
380		-	REGULATION . 5
381		-
382		-	(2) “Pharmacy benefits management services” does not include any service 6
383		-	provided by a nonprofit health maintenance organization that operates as a group model, 7
384		-	provided that the service: 8
385		-
386		-	(i) is provided solely to a member of the nonprofit health 9
387		-	maintenance organization; and 10
388		-
389		-	(ii) is furnished through the internal pharmacy operations of the 11
390		-	nonprofit health maintenance organization. 12
391		-
392		-	[(q)] (T) “Pharmacy benefits manager” means: 13
393		-
394		-	(1) a person that [performs], IN ACCORDANCE WITH A WRITTEN 14
395		-	AGREEMENT WITH A PUR CHASER, EITHER DIRECTLY OR I NDIRECTLY, PROVIDES 15
396		-	ONE OR MORE pharmacy benefits management services; OR 16
397		-
398		-	(2) AN AGENT OR OTHER PR OXY OR REPRESENTATIVE , CONTRACTOR , 17
399		-	INTERMEDIARY , AFFILIATE, SUBSIDIARY, OR RELATED ENTITY OF A PERSON THAT 18
400		-	FACILITATES, PROVIDES, DIRECTS, OR OVERSEES THE PROV ISION OF PHARMACY 19
401		-	BENEFITS MANAGEMENT SERVICES. 20
402		-
403		-	[(r)] (U) “Proprietary information” means: 21
404		-
405		-	(1) a trade secret; 22
406		-
407		-	(2) confidential commercial information; or 23
408		-
409		-	(3) confidential financial information. 24
410		-
411		-	[(s)] (V) “Purchaser” means a person that offers a plan or program in the State, 25
412		-	including the State Employee and Retiree Health and Welfare Benefits Program, that: 26
413		-
414		-	(1) provides prescription drug coverage or benefits in the State; and 27
415		-
416		-	(2) enters into an agreement with a pharmacy benefits manager for the 28
417		-	provision of pharmacy benefits management services. 29
418		-	10 HOUSE BILL 879
419		-
420		-
421		-	[(t)] (W) “Rebate sharing contract” means a contract between a pharmacy 1
422		-	benefits manager and a purchaser under which the pharmacy benefits manager agrees to 2
423		-	share manufacturer payments with the purchaser. 3
424		-
425		-	[(u)] (X) (1) “Therapeutic interchange” means any change from one 4
426		-	prescription drug to another. 5
427		-
428		-	(2) “Therapeutic interchange” does not include: 6
429		-
430		-	(i) a change initiated pursuant to a drug utilization review; 7
431		-
432		-	(ii) a change initiated for patient safety reasons; 8
433		-
434		-	(iii) a change required due to market unavailability of the currently 9
435		-	prescribed drug; 10
436		-
437		-	(iv) a change from a brand name drug to a generic drug in accordance 11
438		-	with § 12–504 of the Health Occupations Article; or 12
439		-
440		-	(v) a change required for coverage reasons because the originally 13
441		-	prescribed drug is not covered by the beneficiary’s formulary or plan. 14
442		-
443		-	[(v)] (Y) “Therapeutic interchange solicitation” means any communication by a 15
444		-	pharmacy benefits manager for the purpose of requesting a therapeutic interchange. 16
445		-
446		-	[(w)] (Z) “Trade secret” has the meaning stated in § 11–1201 of the Commercial 17
447		-	Law Article. 18
448		-
449		-	15–1611.3. 19
450		-
451		-	(A) THIS SECTION APPLIES ONLY TO A PHARMACY B ENEFITS MANAGER 20
452		-	THAT PROVIDES PHARMA CY BENEFITS MANAGEME NT SERVICES ON BEHAL F OF A 21
453		-	CARRIER. 22
454		-
455		-	(B) (1) SUBJECT TO PARAGRAPHS (2) AND (3) OF THIS SUBSECTION , 23
456		-	WHEN CALCULATING A B ENEFICIARY’S CONTRIBUTION TO AN APPLICABLE COST 24
457		-	SHARING REQUIREMENT , A PHARMACY BENEFITS MANAGER SHALL INCLUD E COST 25
458		-	SHARING AMOUNTS PAID BY THE BENEFICIARY O N BEHALF OF THE BENE FICIARY BY 26
459		-	ANOTHER PERSON . 27
460		-
461		-	(2) IF THE APPLICATION OF THE REQUIREMENT UNDE R PARAGRAPH 28
462		-	(1) OF THIS SUBSECTION W OULD RESULT IN HEALT H SAVINGS ACCOUNT 29
463		-	INELIGIBILITY UNDER § 223 OF THE INTERNAL REVENUE CODE, THE REQUIREMENT 30
464		-	SHALL APPLY TO HEALT H SAVINGS ACCOUNT –QUALIFIED HIGH DEDUC TIBLE 31
465		-	HEALTH PLANS WITH RE SPECT TO THE DEDUCTI BLE OF THE PLAN AFTE R THE 32 HOUSE BILL 879 11
466		-
467		-
468		-	BENEFICIARY SATISFIE S THE MINIMUM DEDUCT IBLE UNDER § 223 OF THE 1
469		-	INTERNAL REVENUE CODE. 2
470		-
471		-	(3) FOR ITEMS OR SERVICES THAT ARE PREVENTIVE CARE IN 3
472		-	ACCORDANCE WITH § 223(C)(2)(C) OF THE INTERNAL REVENUE CODE, THE 4
473		-	REQUIREMENTS OF THIS SUBSECTION SHALL APP LY REGARDLESS OF WHE THER THE 5
	380	+	(2) IF THE APPLICATION OF THE R EQUIREMENT UNDER PAR AGRAPH 1
	381	+	(1) OF THIS SUBSECTION W OULD RESULT IN HEALT H SAVINGS ACCOUNT 2
	382	+	INELIGIBILITY UNDER § 223 OF THE INTERNAL REVENUE CODE, THE REQUIREMENT 3
	383	+	SHALL APPLY TO HEALT H SAVINGS ACCOUNT –QUALIFIED HIGH DEDUC TIBLE 4
	384	+	HEALTH PLAN S WITH RESPECT TO TH E DEDUCTIBLE OF THE PLAN AFTER THE 5
474	385		BENEFICIARY SATISFIE S THE MINIMUM DEDUCT IBLE UNDER § 223 OF THE 6
475	386		INTERNAL REVENUE CODE. 7
476	387
477		-	(C) ~~A PHARMACY BENEFITS MA NAGER MAY NOT DIRECT LY~~ OR ~~INDIRECTLY~~ 8
478		-	~~SET, ALTER,~~ ~~IMPLEMENT, OR CONDITION~~ THE ~~TER MS OF HEALTH BENEFIT PLAN~~ 9
479		-	~~COVERAGE, INCLUDING~~ THE ~~BENEFI T DESIGN, BASED IN WHOLE OR IN PART ON~~ 10
480		-	~~INFORMATION ABOUT TH E AVAILABILITY OR AM OUNT~~ OF ~~FINANCIAL OR PRODUCT~~ 11
481		-	~~ASSISTANCE AVAILABLE FOR A PRESCRIPTI ON DRUG~~. 12
	388	+	(3) FOR ITEMS OR SERVICES THAT ARE PREVENTIVE CARE IN 8
	389	+	ACCORDANCE WITH § 223(C)(2)(C) OF THE INTERNAL REVENUE CODE, THE 9
	390	+	REQUIREMENTS OF THIS SUBSECTION SHALL APP LY REGARDLESS OF WHE THER THE 10
	391	+	BENEFICIARY SATISFIE S THE MINIMUM DEDUCT IBLE UNDER § 223 OF THE 11
	392	+	INTERNAL REVENUE CODE. 12
482	393
483		-	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 13
484		-	policies, contracts, and health plans issued, delivered, or renewed in the State on or after 14
485		-	January 1, 2025. 15
	394	+	(C) A PHARMACY BENEFITS MA NAGER MAY NOT DIRECT LY OR INDIRECTLY 13
	395	+	SET, ALTER, IMPLEMENT, OR CONDITION THE TERM S OF HEALTH BENEFIT PLAN 14
	396	+	COVERAGE, INCLUDING THE BENEFI T DESIGN, BASED IN WHOLE OR IN PART ON 15
	397	+	INFORMATION ABOUT TH E AVAILABILITY OR AM OUNT OF FINANCIAL OR PRODUCT 16
	398	+	ASSISTANCE AVAILABLE FOR A PRESCRIPTION D RUG. 17
486	399
487		-	SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 16
488		-	January 1, 2025. 17
	400	+	SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 18
	401	+	policies, contracts, and health plans issued, delivered, or renewed in the State on or after 19
	402	+	January 1, 2025. 20
489	403
	404	+	SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 21
	405	+	January 1, 2025. 22
490	406
491		-
492		-	Approved:
493		-	________________________________________________________________________________
494		-	Governor.
495		-	________________________________________________________________________________
496		-	Speaker of the House of Delegates.
497		-	________________________________________________________________________________
498		-	President of the Senate.