Maryland Legislative Sessions: IPMD Past Supported Bills
2022 Supported Legislation & Legislation of Interest
HB 1014/SB 690
HB 1014/SB 690 – PHARMACY BENEFITS MANAGERS: DEFINITIONS OF CARRIER, ERISA, & PURCHASER - BY DELEGATES KIPKE, KREBS, MORGAN, & SAAB / SENATOR READY
These bills will further expand the Rutledge decision to cover all aspects of ERISA PBMs under the Insurance Code. As you will recall, in last sessions HB 601, as enacted, certain provisions were extended to ERISA PBMs, but other provisions of the Insurance Code were exempted. This bill, as a result of the MIA study, would make all provisions of the Insurance Code PBM provisions applicable to ERISA PBMs as well.
HB 1014 FULL BILL TEXT & STATUS
SB 690 FULL BILL TEXT & STATUS
HB 755/SB 689
HB 755 / SB 689 – PHARMACY BENEFITS MANAGERS: PROHIBITED ACTIONS - BY DELEGATES KREBS, BELCASTRO, CARR, JOHNSON, KIPKE, MORGAN, REILLY, SAAB, SZELIGA, K YOUNG / SENATOR READY
These bills contain certain practices that PBMs will be prohibited from carrying out. Specifically, spread pricing will be banned, different copays between affiliated and independent pharmacies will be banned, required use of mail-order pharmacies will be banned, and “any willing pharmacy provider” would be required of networks PBMs set up.
HB 1006
HB 1006 – PHARMACY BENEFITS MANAGERS: NETWORK ADEQUACY, CREDENTIALING, & REIMBURSEMENT – BY DELEGATE KIPKE
This bill requires PBMs to maintain a reasonable and adequate network, and that a PBM cannot require a pharmacy to obtain additional accreditation beyond what the state requires, as a condition for participating in the network.
HB 1007
HB 1007 – MARYLAND MEDICAL ASSISTANCE PROGRAM & MANAGED CARE ORGANIZATIONS THAT USE PHARMACY BENEFITS MANAGERS: REIMBURSEMENT REQUIREMENTS – By DELEGATE KIPKE
This bill will apply to Medicaid reimbursements to pharmacies. It alters the reimbursement levels for drug products. Requires reimbursement at least equal to NADAC acquisition cost plus professional dispensing fee determined in accordance with the most recent in-state cost of dispensing survey.
HB 1008
HB 1008 – PHARMACY BENEFITS MANAGERS & PURCHASERS: BENEFICIARY CHOICE OF PHARMACY BY DELEGATE KIPKE
Prohibits a PBM from prohibiting a beneficiary from selecting a pharmacy of his choice or denying the pharmacy the right to participate in the network.
HB 1008 FULL BILL TEXT & STATUS
HB 1009
HB 1009 – HEALTH INSURANCE PHARMACY BENEFITS MANAGERS: REIMBURSEMENT & COST SHARING – BY DELEGATE KIPKE
Strengthens the prohibition on PBMs reimbursing a pharmacy in an amount less than the PBM reimburses itself or an affiliate; requires reimbursement at NADAC plus CMMS professional dispensing fee; contains other prohibitions on PBMs.
HB 973/SB 823
HB 973 / SB 823 – PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS & PHARMACY BENEFITS MANAGERS CONTRACTS – BY DELEGATE KELLY / SENATOR KRAMER
Deals with PSAOs. Contracts between PSAOs and PBMs to be filed with Insurance Commissioner. Commissioner may approve or disapprove.
HB 973 FULL BILL TEXT & STATUS
SB 823 FULL BILL TEXT & STATUS
HB 1015
HB 1015 – PHARMACY BENEFITS MANAGERS: PROHIBITIONS RELATED TO REIMBURSEMENT & USE OF SPECIFIC PHARMACY REQUIREMENT – By DELEGATES K YOUNG & KERBS
Repealing the authority of a PBM to require a beneficiary to use a specific pharmacy for a specialty drug and altering the prohibition on PBMs to reimburse a pharmacy in an amount less than the PBM reimburses itself or an affiliate.
HB 1275
HB 1275 – PHARMACY BENEFITS MANAGERS: CONTRACTS WITH PHARMACY SERVICES ADMINISTRATIVE ORGANIZATIONS – By DELEGATE KIPKE
Deals with contracts with PSAOs.
SB 661
SB 661 – REIMBURSEMENT OF PHARMACIST FOR SERVICES RENDERED - BY SENATORS BENSON, BEIDLE, & SMITH
Altering definition of “health care provider” to include pharmacists related to malpractice claims, destruction of records, and HIV testing. Requires insurers and HMOs to reimburse pharmacists at same rate at same services provided by physician or nurse practitioner.
SB 661 FULL BILL TEXT & STATUS
HB 1219
HB 1219 – PHARMACISTS: STATUS AS HEALTHCARE PROVIDERS & REIMBURSEMENT – By DELEGATE BHANDARI
Altering definition of “health care provider” with respect to health care malpractice claims, medical records, and HIV testing; requiring Medicaid and certain insurers to provide coverage for pharmacists under certain circumstances.
2020/2021 Supported Bills
HB 601 SIGNED BY THE GOVERNOR
HB 601 – PBM: DEFINITION OF A PURCHASER AND ERISA – BY DELEGATE KIPKE
STATUS UPDATE: Signed by the Governor
Law Effective January 1, 2022
FOR the purpose of altering the definition of “purchaser” for the purposes of certain provisions of State insurance law governing pharmacy benefits managers to repeal the exclusion of certain persons that provide prescription drug coverage or benefits through plans subject to ERISA; repealing a certain definition, and generally relating to pharmacy benefits managers and plans subject to ERISA.
Importance:
By amending the Insurance Article, this bill streamlines the definition of "pharmacy benefits manager" in relation to their purpose in the healthcare system and implements elements of the Rutledge v PCMA SCOTUS decision by allowing the state to regulate ERISA plan PBM practices. It also places restrictions and guidelines on pharmacy audits to prevent predatory tactics, and broadens the scope of care pharmacies may provide to their patients.
HB 602
HB 602 – EMERGENCY BILL MMCD/PBM REIMBURSEMENT REUIREMENT - BY DELEGATE KIPKE
* A PBM must reimburse the pharmacy an amount that is at least equal to the National Average Drug Acquisition Cost (NADAC), plus the fee for service – professional dispensing fee determined by the Marylan Department of Health or the Maryland Medical Assistance Program in accordance with the most recent in-state cost of dispensing survey
HB 607
HB 607 – STATE HEALTH & WELFARE BENEFITS PROGRAM: REQUIREMENTS FOR SELECTION OF A PHARMACY BENEFITS MANAGER – BY DELEGATE KIPKE
AMENDMENT TO THE 2020 LEGISLATIVE SESSION REVERSE AUCTION BILL
Terms of a participant bidding agreement:
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all bidders must accept as a prerequisite for participation in the reverse auction shall include a requirement that a bidder, if selected as a PBM for the Maryland Prescription Drug Program, pay a fee-for-service professional dispensing fee to a pharmacy which is based on an in-state cost to dispense market survey
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the department shall require that the fee-for-service professional dispensing fee required will be stated by the bidder in the bid submitted in the reverse auction
HB 603
HB 603 – PHARMACY BENEFITS MANAGERS – EXPLANATION OF BENEFITS - BY DELEGATE KIPKE
* On a quarterly basis a PBM shall provide an explanation of benefits statement, on a form approved by the commissioner, to each beneficiary for whom the PBM processed or paid a claim for prescription drugs during the immediately preceding 3-month period.
The EOB will contain the following:
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a copayment or other cost-sharing amount paid by the beneficiary
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the amount of the payment, reimbursement, or other disbursement made to the dispensing pharmacy by the PBM
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the amount billed by the PBM to the purchaser
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other information that the commissioner requires by regulation to ensure that the EOB statement provides the beneficiary with accurate and clear information regarding the processing and reimbursement of claims by the PBM
HB 709 / SB 614
HB 709/SB 614 – PBM - DRUG REIMBURSEMENT - REPORTING REQUIREMENTS – By DELEGATE KREBS / SENATOR JUSTIN READY
This provision of the insurance article will apply to PBMs that contract with Managed Care Organizations (MCOs) in the same manner as they apply to PBMs that contract with carriers.
Beginning January 1, 2022, and every 3 months thereafter, each PBM shall file with the Commissioner a report of all drugs appearing on the National Drug Acquisition Cost (NADAC) List that were reimbursed by the PBM at an amount below the NADAC cost plus the fee-for-service professional dispensing fee determined by the MD Dept. of Health for the MD Medical Assistance Program in accordance with the most recent in-state cost-of-dispensing survey.
For each drug listed on the report the following must be included:
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the month the drug was dispensed
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the quantity of the drug that was dispensed
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the amount the pharmacy was reimbursed per unit or dosage
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whether the dispensing pharmacy was an affiliate of the PBM
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whether the drug was reimbursed in accordance with a state or local government health plan
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the NADAC cost on the day the drug was dispensed
This information will be made available to the public by the Commissioner. This subsection may not be construed to preempt or conflict with any federal law or regulation (ERISA)
HB 819 / SB 615
HB 819/SB 615 – PBMs - PROHIBITED ACTIONS. BY DELEGATE KREBS / SENATOR JUSTIN READY
The bill adds to actions that may not be taken by a Pharmacy Benefit Manager (PBM) against a pharmacy. Under the bill, a PBM may not:
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diminish reimbursement to a pharmacy for a prescription based on patient outcomes;
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engage in the practice of “spread pricing”, which is where the PBM charges a prescription plan one price for a drug, and then pays the pharmacy a lesser amount, the PBM then pocketing the difference;
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deny any pharmacy the right to participate in a prescription plan, as long as the pharmacy agrees to meet the terms and conditions of the plan;
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set different fees for a copay, based on whether the pharmacy is affiliated with an independent or a chain pharmacy;
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require that a beneficiary of a plan use a mail-order pharmacy to fill a prescription.
2019/2020 Supported Bills
HB 756
HB 756 – MARYLAND MEDICAL ASSISTANCE PROGRAM AND MANAGED CARE ORGANIZATIONS THAT USE PHARMACY BENEFITS MANAGERS – REIMBURSEMENT REQUIREMENTS BY DELEGATE KIPKE
* A PBM must reimburse the pharmacy an amount that is at least equal to the National Average Drug Acquisition Cost (NADAC), plus the fee for service – professional dispensing fee determined by the Maryland Medical Assistance program.
Target Effective date: Emergency bill. Immediate.
Status: In Committee
HB 1307
Effective date: 1/1/2021
Status: ENACTED into law without Governor's signature
HB 1307 – PHARMACY BENEFITS MANAGERS – NETWORK ADEQUACY AND REIMBURSEMENT – BY DELEGATE KIPKE, ET.AL.
HB 663
Effective Date: 10/1/2020
Status: ENACTED into law without Governor's signature
HB 0663 – Prescription Drug Monitoring Program - Out-of-State Pharmacists and Discipline for Noncompliance – By Chair, Health and Government Operations Committee (Departmental - MDH)
HB 1100
Effective Date: 6/1/2021
Status: ENACTED into law without Governor's signature
HB 1100 – Prescription Drug Affordability Board - Meetings, Legal Advisor, and Technical Changes – BY DELEGATE PENDERGRASS
SB 99
Effective Date: 1/1/2021
Status: ENACTED into law without Governor's signature
SB 0099 – Health Insurance Benefit Cards, Prescription Benefit Cards and Other Technology - Identification of Regulatory Agency – By Chair, Finance Committee (Departmental - MIA)
SB 477/HB 1462
Effective Date: 10/1/2021
Status: ENACTED into law without Governor's signature
SB 0477/HB 1462 – Public Health - Emergency Use Auto-Injectable Epinephrine Proram - Revisions – BY SENATOR CAROZZA
HB 885
HB 885 – PHARMACY BENEFITS MANAGERS – DUTIES AND OBLIGATIONS BY DELEGATES SAMPLE-HUGHES & KIPKE
* Establishes a fiduciary relationship between the PBM and the plan sponsor and beneficiary. In essence, the duties and obligations of the PBM must be consistent with the best interest of the plan sponsor (purchaser) and beneficiaries (subscribers) and not just what is in the best interest of the PBM.
Target Effective date: 10/1/2020
Status: In Committee
HB 652/SB 931
Effective date: Emergency bill. Immediate.
Status: ENACTED into law without Governor's signature
HB 652/SB 931 – MARYLAND MEDICAL ASSISTANCE PROGRAM AND HEALTH INSURANCE – SPECIALTY DRUGS – DEFINITION BY DELEGATE KIPKE, ET.AL. AND CROSS-FILED BY SENATOR HAYES
See full law text & description
HB 512
Effective date: 1/1/2022
Status: ENACTED into law without Governor's signature
HB 0512 – Drugs and Devices - Electronic Prescriptions - Controlled Dangerous Substances – BY DELEGATE BARRON
See full law text & description
SB 669/HB 1095
Effective date: 6/1/2020
Status: ENACTED into law without Governor's signature
SB 0669/HB 1095 – Public Health - Prescription Drug Affordability Board and Fund – By President (Prescription Drug Affordability Board and Fund)
See full law text & description
HB 749
Effective date: 10/1/2022
Status: ENACTED into law without Governor's signature
HB 0749 – Health Occupations - Dental Hygienists - Authority to Prescribe and Administer Medication – BY DELEGATE KIPKE
See full law text & description
HB 1273
Effective date: 10/1/2020
Status: ENACTED into law without Governor's signature
HB 1273 – Health Insurance – Audits of Pharmacies or Pharmacists – Authorization to Withdraw and Resubmit Claims – BY DELEGATE JOHNSON
See full law text & description
HB 1462/SB 477
Effective date: 10/1/2020
Status: ENACTED into law without Governor's signature
HB 1462/SB 0477 – Public Health - Emergency Use Auto-Injectable Epinephrine Proram - Revisions – BY DELEGATE METZGAR
See full law text & description
SB 166
Effective date: 1/1/2022
Status: ENACTED into law without Governor's signature
SB 0166 – Drugs and Devices - Electronic Prescriptions - Controlled Dangerous Substances – BY SENATOR KELLEY
See full law text & description
HB 1095/SB 669
FAILED
Status: Vetoed by Governor
HB 1095/SB 0669 – Public Health - Prescription Drug Affordability Board and Fund – By Speaker (Prescription Drug Affordability Board)
See full law text & description
SB 931/HB 652
Effective date: Emergency bill. Immediate.
Status: ENACTED into law without Governor's signature
SB 0931/HB 0652 – Maryland Medical Assistance Program and Health Insurance - Specialty Drugs - BY SENATOR HAYES
See full law text & description