| 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 | *hb1243* | |
| 9 | 6 | ||
| 10 | 7 | HOUSE BILL 1243 | |
| 11 | 8 | J5 5lr2645 | |
| 12 | 9 | CF SB 975 | |
| 13 | - | By: Delegate S. Johnson Delegates S. Johnson, Alston, Bagnall, Bhandari, | |
| 14 | - | Chisholm, Cullison, Guzzone, Hill, Hutchinson, Kaiser, Kerr, Kipke, Lopez, | |
| 15 | - | Martinez, M. Morgan, Pena–Melnyk, Reilly, Rosenberg, Ross, Szeliga, | |
| 16 | - | Taveras, White Holland, Woods, and Woorman | |
| 10 | + | By: Delegate S. Johnson | |
| 17 | 11 | Introduced and read first time: February 7, 2025 | |
| 18 | 12 | Assigned to: Health and Government Operations | |
| 19 | - | Committee Report: Favorable with amendments | |
| 20 | - | House action: Adopted | |
| 21 | - | Read second time: March 1, 2025 | |
| 22 | 13 | ||
| 23 | - | ||
| 14 | + | A BILL ENTITLED | |
| 24 | 15 | ||
| 25 | 16 | AN ACT concerning 1 | |
| 26 | 17 | ||
| 27 | 18 | Health Insurance – Coverage for Specialty Drugs 2 | |
| 28 | 19 | ||
| 29 | 20 | FOR the purpose of prohibiting certain insurers, nonprofit health service plans, and health 3 | |
| 30 | 21 | maintenance organizations from excluding coverage for certain specialty drugs that 4 | |
| 31 | 22 | are administered or dispensed by a provider that meets certain criteria; requiring 5 | |
| 32 | 23 | the reimbursement rate for certain specialty drugs to meet certain criteria; and 6 | |
| 33 | 24 | generally relating to health insurance coverage for specialty drugs. 7 | |
| 34 | 25 | ||
| 35 | 26 | BY repealing and reenacting, without amendments, 8 | |
| 36 | 27 | Article – Insurance 9 | |
| 37 | 28 | Section 15–847(a)(1) and (5) 10 | |
| 38 | 29 | Annotated Code of Maryland 11 | |
| 39 | 30 | (2017 Replacement Volume and 2024 Supplement) 12 | |
| 40 | 31 | ||
| 41 | 32 | BY repealing and reenacting, with amendments, 13 | |
| 42 | 33 | Article – Insurance 14 | |
| 43 | 34 | Section 15–847(d), 15–1611.1, and 15–1612 15 | |
| 44 | 35 | Annotated Code of Maryland 16 | |
| 45 | 36 | (2017 Replacement Volume and 2024 Supplement) 17 | |
| 46 | 37 | ||
| 47 | 38 | BY adding to 18 | |
| 48 | - | Article – Insurance 19 2 HOUSE BILL 1243 | |
| 39 | + | Article – Insurance 19 | |
| 40 | + | Section 15–847.2 20 | |
| 41 | + | Annotated Code of Maryland 21 | |
| 42 | + | (2017 Replacement Volume and 2024 Supplement) 22 | |
| 43 | + | ||
| 44 | + | SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 23 | |
| 45 | + | That the Laws of Maryland read as follows: 24 | |
| 46 | + | ||
| 47 | + | Article – Insurance 25 | |
| 48 | + | 2 HOUSE BILL 1243 | |
| 49 | 49 | ||
| 50 | 50 | ||
| 51 | - | Section 15–847(h) and 15–847.2 1 | |
| 52 | - | Annotated Code of Maryland 2 | |
| 53 | - | (2017 Replacement Volume and 2024 Supplement) 3 | |
| 51 | + | 15–847. 1 | |
| 54 | 52 | ||
| 55 | - | SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 4 | |
| 56 | - | That the Laws of Maryland read as follows: 5 | |
| 53 | + | (a) (1) In this section the following words have the meanings indicated. 2 | |
| 57 | 54 | ||
| 58 | - | ||
| 55 | + | (5) (i) “Specialty drug” means a prescription drug that: 3 | |
| 59 | 56 | ||
| 60 | - | 15–847. 7 | |
| 57 | + | 1. is prescribed for an individual with a complex or chronic 4 | |
| 58 | + | medical condition or a rare medical condition; 5 | |
| 61 | 59 | ||
| 62 | - | | |
| 60 | + | 2. costs $600 or more for up to a 30–day supply; 6 | |
| 63 | 61 | ||
| 64 | - | | |
| 62 | + | 3. is not typically stocked at retail pharmacies; and 7 | |
| 65 | 63 | ||
| 66 | - | | |
| 67 | - | ||
| 64 | + | 4. A. requires a difficult or unusual process of delivery to 8 | |
| 65 | + | the patient in the preparation, handling, storage, inventory, or distribution of the drug; or 9 | |
| 68 | 66 | ||
| 69 | - | 2. costs $600 or more for up to a 30–day supply; 12 | |
| 67 | + | B. requires enhanced patient education, management, or 10 | |
| 68 | + | support, beyond those required for traditional dispensing, before or after administration of 11 | |
| 69 | + | the drug. 12 | |
| 70 | 70 | ||
| 71 | - | 3. is not typically stocked at retail pharmacies; and 13 | |
| 71 | + | (ii) “Specialty drug” does not include a prescription drug prescribed 13 | |
| 72 | + | to treat diabetes, HIV, or AIDS. 14 | |
| 72 | 73 | ||
| 73 | - | 4. A. requires a difficult or unusual process of delivery to 14 | |
| 74 | - | the patient in the preparation, handling, storage, inventory, or distribution of the drug; or 15 | |
| 74 | + | (d) Subject to § 15–805 of this subtitle [and], notwithstanding § 15–806 of this 15 | |
| 75 | + | subtitle, [nothing in] AND EXCEPT AS PROVIDED IN § 15–847.2 OF THIS SUBTITLE, this 16 | |
| 76 | + | article or regulations adopted under this article [precludes] DO NOT PRECLUDE an entity 17 | |
| 77 | + | subject to this section from requiring a covered specialty drug to be obtained through: 18 | |
| 75 | 78 | ||
| 76 | - | B. requires enhanced patient education, management, or 16 | |
| 77 | - | support, beyond those required for traditional dispensing, before or after administration of 17 | |
| 78 | - | the drug. 18 | |
| 79 | + | (1) a designated pharmacy or other source authorized under the Health 19 | |
| 80 | + | Occupations Article to dispense or administer prescription drugs; or 20 | |
| 79 | 81 | ||
| 80 | - | ( | |
| 81 | - | ||
| 82 | + | (2) a pharmacy participating in the entity’s provider network, if the entity 21 | |
| 83 | + | determines that the pharmacy: 22 | |
| 82 | 84 | ||
| 83 | - | (d) Subject to SUBSECTION (H) OF THIS SECTION AND § 15–805 of this subtitle 21 | |
| 84 | - | [and], notwithstanding § 15–806 of this subtitle, [nothing in] AND EXCEPT AS PROVID ED 22 | |
| 85 | - | IN § 15–847.2 OF THIS SUBTITLE , this article or regulations adopted under this article 23 | |
| 86 | - | [precludes] DO NOT PRECLUDE an entity subject to this section from requiring a covered 24 | |
| 87 | - | specialty drug to be obtained through: 25 | |
| 85 | + | (i) meets the entity’s performance standards; and 23 | |
| 88 | 86 | ||
| 89 | - | (1) a designated pharmacy or other source authorized under the Health 26 | |
| 90 | - | Occupations Article to dispense or administer prescription drugs; or 27 | |
| 87 | + | (ii) accepts the entity’s network reimbursement rates. 24 | |
| 91 | 88 | ||
| 92 | - | (2) a pharmacy participating in the entity’s provider network, if the entity 28 | |
| 93 | - | determines that the pharmacy: 29 | |
| 89 | + | 15–847.2. 25 | |
| 94 | 90 | ||
| 95 | - | (i) meets the entity’s performance standards; and 30 | |
| 91 | + | (A) IN THIS SECTION, “SPECIALTY DRUG ” HAS THE MEANING STAT ED IN § 26 | |
| 92 | + | 15–847 OF THIS SUBTITLE . 27 | |
| 96 | 93 | ||
| 97 | - | (ii) accepts the entity’s network reimbursement rates. 31 HOUSE BILL 1243 3 | |
| 94 | + | (B) (1) THIS SECTION APPLIES TO: 28 | |
| 95 | + | HOUSE BILL 1243 3 | |
| 96 | + | ||
| 97 | + | ||
| 98 | + | (I) INSURERS AND NONPROF IT HEALTH SERVICE PLANS THAT 1 | |
| 99 | + | PROVIDE COVERAGE FOR PRESCRIPTION DRUGS U NDER INDIVIDUAL , GROUP, OR 2 | |
| 100 | + | BLANKET HEALTH INSUR ANCE POLICIES OR CON TRACTS THAT ARE ISSU ED OR 3 | |
| 101 | + | DELIVERED IN THE STATE; AND 4 | |
| 102 | + | ||
| 103 | + | (II) HEALTH MAINTENANCE O RGANIZATIONS THAT PR OVIDE 5 | |
| 104 | + | COVERAGE FOR PRESCRI PTION DRUGS UNDER IN DIVIDUAL OR GROUP CO NTRACTS 6 | |
| 105 | + | THAT ARE ISSUED OR D ELIVERED IN THE STATE. 7 | |
| 106 | + | ||
| 107 | + | (2) AN INSURER, A NONPROFIT HEALTH S ERVICE PLAN, OR A HEALTH 8 | |
| 108 | + | MAINTENANCE ORGANIZA TION THAT PROVIDES C OVERAGE FOR PRESCRIP TION 9 | |
| 109 | + | DRUGS THROUGH A PHAR MACY BENEFITS MA NAGER IS SUBJECT TO THE 10 | |
| 110 | + | REQUIREMENTS OF THIS SECTION. 11 | |
| 111 | + | ||
| 112 | + | (C) AN ENTITY SUBJECT TO THIS SECTION MAY NOT EXCLUDE COVERAGE 12 | |
| 113 | + | FOR A COVERED SPECIA LTY DRUG ADMINISTERE D OR DISPENSED BY A PROVIDER 13 | |
| 114 | + | UNDER § 12–102 OF THE HEALTH OCCUPATIONS ARTICLE IF THE ENTITY 14 | |
| 115 | + | DETERMINES THAT: 15 | |
| 116 | + | ||
| 117 | + | (1) THE PROVIDER THAT AD MINISTERS OR DISPENS ES THE COVERED 16 | |
| 118 | + | SPECIALTY DRUG : 17 | |
| 119 | + | ||
| 120 | + | (I) IS AN IN–NETWORK PROVIDER OF COVERED MEDICAL 18 | |
| 121 | + | ONCOLOGY SERVICES ; AND 19 | |
| 122 | + | ||
| 123 | + | (II) COMPLIES WITH STATE REGULATIONS FOR THE 20 | |
| 124 | + | ADMINISTERING AND DI SPENSING OF SPECIALT Y DRUGS; AND 21 | |
| 125 | + | ||
| 126 | + | (2) THE COVERED SPECIALT Y DRUG IS: 22 | |
| 127 | + | ||
| 128 | + | (I) INFUSED, AUTO–INJECTED, OR AN ORAL TARGETED 23 | |
| 129 | + | IMMUNE MODULATOR ; OR 24 | |
| 130 | + | ||
| 131 | + | (II) AN ORAL MEDICATION T HAT: 25 | |
| 132 | + | ||
| 133 | + | 1. REQUIRES COMPLEX DOS ING BASED ON CLINICA L 26 | |
| 134 | + | PRESENTATION ; OR 27 | |
| 135 | + | ||
| 136 | + | 2. IS USED CONCOMITANTL Y WITH OTHER INFUSION OR 28 | |
| 137 | + | RADIATION THERAPIES . 29 | |
| 138 | + | ||
| 139 | + | (D) THE REIMBURSEMENT RAT E FOR SPECIALTY DRUG S COVERED UNDER 30 | |
| 140 | + | THIS SECTION SHALL B E: 31 4 HOUSE BILL 1243 | |
| 98 | 141 | ||
| 99 | 142 | ||
| 100 | 143 | ||
| 101 | - | (H) THIS SECTION MAY NOT BE CONSTRUED TO SUPE RSEDE THE AUTHORITY 1 | |
| 102 | - | OF THE HEALTH SERVICES COST REVIEW COMMISSION TO SET RAT ES FOR 2 | |
| 103 | - | SPECIALTY DRUGS ADMI NISTERED TO PATIENTS IN A SETTING REGULAT ED BY THE 3 | |
| 104 | - | HEALTH SERVICES COST REVIEW COMMISSION. 4 | |
| 144 | + | (1) AGREED TO BY THE COV ERED, IN–NETWORK PROVIDER AND THE 1 | |
| 145 | + | ENTITY SUBJECT TO TH IS SECTION; AND 2 | |
| 105 | 146 | ||
| 106 | - | 15–847.2. 5 | |
| 147 | + | (2) BILLED AT A NONHOSPI TAL LEVEL OF CARE OR PLA CE OF 3 | |
| 148 | + | SERVICE. 4 | |
| 107 | 149 | ||
| 108 | - | (A) IN THIS SECTION, “SPECIALTY DRUG ” HAS THE MEANING STAT ED IN § 6 | |
| 109 | - | 15–847 OF THIS SUBTITLE . 7 | |
| 150 | + | (E) THIS SECTION DOES NOT PROHIBIT AN ENTITY S UBJECT TO THIS 5 | |
| 151 | + | SECTION FROM REFUSIN G TO AUTHORIZE OR AP PROVE OR FROM DENYIN G 6 | |
| 152 | + | COVERAGE FOR A COVER ED SPECIALTY DRUG AD MINISTERED OR DISPEN SED BY A 7 | |
| 153 | + | PROVIDER IF ADMINIST ERING OR DISPENSING THE DRU G FAILS TO SATISFY 8 | |
| 154 | + | MEDICAL NECESSITY CR ITERIA. 9 | |
| 110 | 155 | ||
| 111 | - | ||
| 156 | + | 15–1611.1. 10 | |
| 112 | 157 | ||
| 113 | - | (I) INSURERS AND NONPROF IT HEALTH SERVICE PL ANS THAT 9 | |
| 114 | - | PROVIDE COVERAGE FOR PRESCRIPTION DRUGS UNDER INDIVIDUAL , GROUP, OR 10 | |
| 115 | - | BLANKET HEALTH INSUR ANCE POLICIES OR CON TRACTS THAT ARE ISSU ED OR 11 | |
| 116 | - | DELIVERED IN THE STATE; AND 12 | |
| 158 | + | (a) This section applies only to a pharmacy benefits manager that provides 11 | |
| 159 | + | pharmacy benefits management services on behalf of a carrier. 12 | |
| 117 | 160 | ||
| 118 | - | ( | |
| 119 | - | ||
| 120 | - | ||
| 161 | + | (b) Except as provided in subsection (c) of this section, a pharmacy benefits 13 | |
| 162 | + | manager may not require that a beneficiary use a specific pharmacy or entity to fill a 14 | |
| 163 | + | prescription if: 15 | |
| 121 | 164 | ||
| 122 | - | (2) AN INSURER, A NONPROFIT HEALTH S ERVICE PLAN, OR A HEALTH 16 | |
| 123 | - | MAINTENANCE ORGANIZA TION THAT PROVIDES C OVERAGE FOR PRESCRIP TION 17 | |
| 124 | - | DRUGS THROUGH A PHAR MACY BENEFITS MANAGE R IS SUBJECT TO THE 18 | |
| 125 | - | REQUIREMENTS OF THIS SECTION. 19 | |
| 165 | + | (1) the pharmacy benefits manager or a corporate affiliate of the pharmacy 16 | |
| 166 | + | benefits manager has an ownership interest in the pharmacy or entity; or 17 | |
| 126 | 167 | ||
| 127 | - | (C) AN ENTITY SUBJECT TO THIS SECTION MAY NOT EXCLUDE COVERAGE 20 | |
| 128 | - | FOR A COVERED SPECIA LTY DRUG ADMINISTERE D OR DISPENSED BY A PROVIDER 21 | |
| 129 | - | UNDER § 12–102 OF THE HEALTH OCCUPATIONS ARTICLE IF THE ENTITY 22 | |
| 130 | - | DETERMINES THAT : 23 | |
| 168 | + | (2) the pharmacy or entity has an ownership interest in the pharmacy 18 | |
| 169 | + | benefits manager or a corporate affiliate of the pharmacy benefits manager. 19 | |
| 131 | 170 | ||
| 132 | - | (1) THE PROVIDER THAT AD MINISTERS OR DISPENSES THE COVERE D 24 | |
| 133 | - | SPECIALTY DRUG : 25 | |
| 171 | + | (c) [A] EXCEPT AS PROVIDED IN § 15–847.2 OF THIS TITLE, A pharmacy 20 | |
| 172 | + | benefits manager may require a beneficiary to use a specific pharmacy or entity for a 21 | |
| 173 | + | specialty drug as defined in § 15–847 of this title. 22 | |
| 134 | 174 | ||
| 135 | - | (I) IS AN IN–NETWORK PROVIDER OF COVERED MEDICAL 26 | |
| 136 | - | ONCOLOGY SERVICES ; AND 27 | |
| 175 | + | 15–1612. 23 | |
| 137 | 176 | ||
| 138 | - | ( | |
| 139 | - | ||
| 177 | + | (a) This section applies only to a pharmacy benefits manager that provides 24 | |
| 178 | + | pharmacy benefits management services on behalf of a carrier. 25 | |
| 140 | 179 | ||
| 141 | - | (2) THE COVERED SPECIALT Y DRUG IS: 30 | |
| 142 | - | 4 HOUSE BILL 1243 | |
| 180 | + | (b) This section does not apply to reimbursement: 26 | |
| 181 | + | ||
| 182 | + | (1) EXCEPT AS PROVIDED I N § 15–847.2 OF THIS TITLE, for specialty 27 | |
| 183 | + | drugs; 28 | |
| 184 | + | ||
| 185 | + | (2) for mail order drugs; or 29 | |
| 186 | + | ||
| 187 | + | (3) to a chain pharmacy with more than 15 stores or a pharmacist who is 30 | |
| 188 | + | an employee of the chain pharmacy. 31 HOUSE BILL 1243 5 | |
| 143 | 189 | ||
| 144 | 190 | ||
| 145 | - | (I) INFUSED, AUTO–INJECTED, OR AN ORAL TARGETED 1 | |
| 146 | - | IMMUNE MODULATOR ; OR 2 | |
| 147 | 191 | ||
| 148 | - | (II) AN ORAL MEDICATION T HAT: 3 | |
| 192 | + | (c) A pharmacy benefits manager may not reimburse a pharmacy or pharmacist 1 | |
| 193 | + | for a pharmaceutical product or pharmacist service in an amount less than the amount that 2 | |
| 194 | + | the pharmacy benefits manager reimburses itself or an affiliate for providing the same 3 | |
| 195 | + | product or service. 4 | |
| 149 | 196 | ||
| 150 | - | 1. REQUIRES COMPLEX DOS ING BASED ON CLINICA L 4 | |
| 151 | - | PRESENTATION ; OR 5 | |
| 197 | + | SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 5 | |
| 198 | + | policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 6 | |
| 199 | + | after January 1, 2026. 7 | |
| 152 | 200 | ||
| 153 | - | | |
| 154 | - | ||
| 201 | + | SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 8 | |
| 202 | + | January 1, 2026. 9 | |
| 155 | 203 | ||
| 156 | - | (D) (1) THE SUBJECT TO SUBSECTION (F) OF THIS SECTION , THE 8 | |
| 157 | - | REIMBURSEMENT RATE F OR SPECIALTY DRUGS COVE RED UNDER THIS SECTI ON 9 | |
| 158 | - | SHALL BE: 10 | |
| 159 | - | ||
| 160 | - | (1) (I) AGREED TO BY THE COV ERED, IN–NETWORK PROVIDER AND 11 | |
| 161 | - | THE ENTITY SUBJECT T O THIS SECTION; AND 12 | |
| 162 | - | ||
| 163 | - | (2) (II) BILLED AT A NONHOSPITAL LEVEL OF CARE OR PLACE OF 13 | |
| 164 | - | SERVICE. 14 | |
| 165 | - | ||
| 166 | - | (2) UNLESS OTHERWISE AGRE ED TO BY THE COVERED , IN–NETWORK 15 | |
| 167 | - | PROVIDER AND THE ENT ITY SUBJECT TO THIS SECTION, THE REIMBURSEMENT RA TE 16 | |
| 168 | - | FOR SPECIALTY DRUGS COVERED UNDER THIS S ECTION MAY NOT EXCEE D THE RATE 17 | |
| 169 | - | APPLICABLE TO A DESI GNATED SPECIALTY PHA RMACY FOR DISPENSING THE 18 | |
| 170 | - | COVERED SPECIALTY DR UGS. 19 | |
| 171 | - | ||
| 172 | - | (E) THIS SECTION DOES NOT PROHIBIT AN ENTITY S UBJECT TO THIS 20 | |
| 173 | - | SECTION FROM REFUSIN G TO AUTHORIZE OR AP PROVE OR FROM DENYIN G 21 | |
| 174 | - | COVERAGE FOR A COVER ED SPECIALTY DRUG ADMINISTERED OR DISP ENSED BY A 22 | |
| 175 | - | PROVIDER IF ADMINIST ERING OR DISPENSING THE DRUG FAILS TO SA TISFY 23 | |
| 176 | - | MEDICAL NECESSITY CR ITERIA. 24 | |
| 177 | - | ||
| 178 | - | (F) THIS SECTION MAY NOT BE CONSTRUED TO SUPE RSEDE THE AUTHORITY 25 | |
| 179 | - | OF THE HEALTH SERVICES COST REVIEW COMMISSION TO SET RAT ES FOR 26 | |
| 180 | - | SPECIALTY DRUGS ADMIN ISTERED TO PATIENTS IN A SETTING REGULAT ED BY THE 27 | |
| 181 | - | HEALTH SERVICES COST REVIEW COMMISSION. 28 | |
| 182 | - | ||
| 183 | - | 15–1611.1. 29 | |
| 184 | - | ||
| 185 | - | (a) This section applies only to a pharmacy benefits manager that provides 30 | |
| 186 | - | pharmacy benefits management services on behalf of a carrier. 31 | |
| 187 | - | HOUSE BILL 1243 5 | |
| 188 | - | ||
| 189 | - | ||
| 190 | - | (b) Except as provided in subsection (c) of this section, a pharmacy benefits 1 | |
| 191 | - | manager may not require that a beneficiary use a specific pharmacy or entity to fill a 2 | |
| 192 | - | prescription if: 3 | |
| 193 | - | ||
| 194 | - | (1) the pharmacy benefits manager or a corporate affiliate of the pharmacy 4 | |
| 195 | - | benefits manager has an ownership interest in the pharmacy or entity; or 5 | |
| 196 | - | ||
| 197 | - | (2) the pharmacy or entity has an ownership interest in the pharmacy 6 | |
| 198 | - | benefits manager or a corporate affiliate of the pharmacy benefits manager. 7 | |
| 199 | - | ||
| 200 | - | (c) [A] EXCEPT AS PRO VIDED IN § 15–847.2 OF THIS TITLE, A pharmacy 8 | |
| 201 | - | benefits manager may require a beneficiary to use a specific pharmacy or entity for a 9 | |
| 202 | - | specialty drug as defined in § 15–847 of this title. 10 | |
| 203 | - | ||
| 204 | - | 15–1612. 11 | |
| 205 | - | ||
| 206 | - | (a) This section applies only to a pharmacy benefits manager that provides 12 | |
| 207 | - | pharmacy benefits management services on behalf of a carrier. 13 | |
| 208 | - | ||
| 209 | - | (b) This section does not apply to reimbursement: 14 | |
| 210 | - | ||
| 211 | - | (1) EXCEPT AS PROVIDED I N § 15–847.2 OF THIS TITLE, for specialty 15 | |
| 212 | - | drugs; 16 | |
| 213 | - | ||
| 214 | - | (2) for mail order drugs; or 17 | |
| 215 | - | ||
| 216 | - | (3) to a chain pharmacy with more than 15 stores or a pharmacist who is 18 | |
| 217 | - | an employee of the chain pharmacy. 19 | |
| 218 | - | ||
| 219 | - | (c) A pharmacy benefits manager may not reimburse a pharmacy or pharmacist 20 | |
| 220 | - | for a pharmaceutical product or pharmacist service in an amount less than the amount that 21 | |
| 221 | - | the pharmacy benefits manager reimburses itself or an affiliate for providing the same 22 | |
| 222 | - | product or service. 23 | |
| 223 | - | ||
| 224 | - | SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall apply to all 24 | |
| 225 | - | policies, contracts, and health benefit plans issued, delivered, or renewed in the State on or 25 | |
| 226 | - | after January 1, 2026. 26 | |
| 227 | - | ||
| 228 | - | SECTION 3. AND BE IT FURTHER ENACTED, That this Act shall take effect 27 | |
| 229 | - | January 1, 2026. 28 |