Maryland 2025 Regular Session

Maryland Senate Bill SB438 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	sb0438
6	6
7	7	SENATE BILL 438
8	8	J5 EMERGENCY BILL 5lr2543
9	9	SB 1021/24 – FIN CF 5lr2785
10	10	By: Senator Lam
11	11	Introduced and read first time: January 21, 2025
12	12	Assigned to: Finance
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 service 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	(2023 Replacement Volume and 2024 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	(2023 Replacement Volume and 2024 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 2024 Supplement) 25
46	46
47	47	BY adding to 26
48	48	Article – Insurance 27 2 SENATE BILL 438
49	49
50	50
51	51	Section 15–1632 1
52	52	Annotated Code of Maryland 2
53	53	(2017 Replacement Volume and 2024 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] MINIMUM reimbursement levels for the drug products for which 10
65	65	there is a generic equivalent authorized under § 12–504 of the Health Occupations Article[, 11
66	66	based on 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 FEE –FOR–SERVICE 16
72	72	PROFESSIONAL DISPENS ING FEE DETERMINED B Y THE DEPARTMENT IN 17
73	73	ACCORDANCE WITH THE MOST RECENT IN –STATE COST–OF–DISPENSING SURVEY . 18
74	74
75	75	[(2)] (3) [If] EXCEPT AS PROVIDED IN PARAGRAPH (4) OF THIS 19
76	76	SUBSECTION, IF a prescriber directs a specific brand name drug, the reimbursement level 20
77	77	shall be based on the [cost] NATIONAL AVERAGE DRUG ACQUISITION COST of the 21
78	78	brand name product PLUS THE FEE–FOR–SERVICE PROFESSIONAL DISPENSING FEE 22
79	79	DETERMINED BY THE DEPARTMENT IN ACCORDA NCE WITH THE MOST RECENT 23
80	80	IN–STATE COST–OF–DISPENSING SURVEY . 24
81	81
82	82	(4) PARAGRAPHS (2) AND (3) OF THIS SUBSECTION D O NOT APPLY TO: 25
83	83
84	84	(I) A PHARMACY OWNED BY OR UNDER THE SAME CORPO RATE 26
85	85	AFFILIATION AS A PHA RMACY BENEFITS MANAG ER; OR 27
86	86
87	87	(II) A MAIL ORDER PHARMACY . 28
88	88
89	89	(F) THE PROVISIONS OF § 15–1632 OF THE INSURANCE ARTICLE APPLY TO 29
90	90	A MANAGED CARE ORGAN IZATION THAT USES A PHARMACY BENEFITS MA NAGER TO 30
91	91	MANAGE PRESCRIPTION DRUG COVERAGE BENEFI TS ON BEHALF OF THE MANAGED 31
92	92	CARE ORGANIZATION . 32
93	93
94	94	Article – Insurance 33
95	95	SENATE BILL 438 3
96	96
97	97
98	98	15–1601. 1
99	99
100	100	(s) (1) “Purchaser” means a person that offers a plan or program in the State, 2
101	101	including the State Employee and Retiree Health and Welfare Benefits Program, AN 3
102	102	INSURER, A NONPROFIT HEALTH S ERVICE PLAN , OR A HEALTH MAINTENA NCE 4
103	103	ORGANIZATION , that: 5
104	104
105	105	[(1)] (I) provides prescription drug coverage or benefits in the State; and 6
106	106
107	107	[(2)] (II) enters into an agreement with a pharmacy benefits manager for 7
108	108	the provision of pharmacy benefits management services. 8
109	109
110	110	(2) “PURCHASER” DOES NOT INCLUDE A N ONPROFIT HEALTH 9
111	111	MAINTENANCE ORGANIZA TION THAT: 10
112	112
113	113	(I) OPERATES AS A GROUP MODEL; 11
114	114
115	115	(II) PROVIDES SERVICES SO LELY TO A MEMBER OR PATIENT OF 12
116	116	THE NONPROFIT HEALTH MAINTENANCE ORGANIZA TION; AND 13
117	117
118	118	(III) FURNISHES SERVICES T HROUGH THE INTERNAL PHARMACY 14
119	119	OPERATIONS OF THE NONPROFIT HEALTH MAINTENANCE ORGANIZA TION. 15
120	120
121	121	15–1632. 16
122	122
123	123	A PHARMACY BENEFITS MA NAGER THAT CONTRACTS WITH A PHARMACY ON 17
124	124	BEHALF OF A MANAGED CARE ORGANIZATION , AS DEFINED IN § 15–101 OF THE 18
125	125	HEALTH – GENERAL ARTICLE, SHALL REIMBURSE THE PHARMACY AN AMOUNT 19
126	126	THAT IS AT LEAST EQU AL TO THE NATIONAL AVERAGE DRUG ACQUISITION COST 20
127	127	PLUS THE FEE–FOR–SERVICE PROFESSIONAL DISPENSING FEE DETER MINED BY THE 21
128	128	MARYLAND DEPARTMENT OF HEALTH FOR THE MARYLAND MEDICAL ASSISTANCE 22
129	129	PROGRAM IN ACCORDANCE WITH THE MOST RECENT IN–STATE 23
130	130	COST–OF–DISPENSING SURVEY . 24
131	131
132	132	SECTION 2. AND BE IT FURTHER ENACTED, That this Act is an emergency 25
133	133	measure, is necessary for the immediate preservation of the public health or safety, has 26
134	134	been passed by a yea and nay vote supported by three–fifths of all the members elected to 27
135	135	each of the two Houses of the General Assembly, and shall take effect from the date it is 28
136	136	enacted. 29
137	137
138	138