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​HB 756 – MARYLAND MEDICAL ASSISTANCE PROGRAM AND MANAGED CARE ORGANIZATIONS THAT USE PHARMACY BENEFITS MANAGERS – REIMBURSEMENT REQUIREMENTS BY DELEGATE KIPKE

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*   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.

Effective date:  Emergency bill.

HB 756 Hearing Scheduled:  HGO on 2/27/2020 at 1:00 PM

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HB 1307 – PHARMACY BENEFITS MANAGERS – NETWORK ADEQUACY AND REIMBURSEMENT – BY DELEGATE KIPKE, ET.AL.

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  *   The Insurance Commissioner is authorized to require a PBM to maintain adequate and accessible PBM networks consisting of contracted pharmacies that provide convenient patient access to pharmacy services.  It further requires that the PBM submit the compensation program to ensure that the reimbursement paid to pharmacies for services is fair and reasonable.  A mail-order pharmacy may not be included in determining a PBM’s network adequacy.

  *   A PBM may not require a pharmacy, as a condition to participate in the PBM network, to maintain accreditation, certification or credentialing that is inconsistent with State requirements for licensure.

  *   A PBM may not, directly or indirectly, charge a contracted pharmacy a fee or performance-based reimbursement that is related to the adjudication of a claim that is not specifically enumerated by the PBM at the time of claim processing.

  *   A pharmacy may decline to dispense a prescription drug that is reimbursed below the pharmacy acquisition cost.

Effective date:  6/1/2020

HB 1307 Hearing Scheduled:    HGO on 2/27/2020 at 1:00 PM

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​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

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*   Prohibits the Secretary of Health from defining drugs prescribed to treat diabetes, HIV or AIDS to be specialty drugs for the providing services under the Maryland Medical Assistance program and non-ERISA commercial prescription plans.

Effective date:  Emergency bill.

HB 652 / SB 931 Hearing Scheduled:  HGO on 2/27/2020 at 1:00 PM

HB 652 / SB 931 Hearing Scheduled:  FIN on 3/4/2020 at 1:00 PM

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​HB 885 – PHARMACY BENEFITS MANAGERS – DUTIES AND OBLIGATIONS BY DELEGATES SAMPLE-HUGHES & KIPKE

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*   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.

Effective date:  10/1/2020

HB 885 Hearing Scheduled:  HGO on 2/27/2020 at 1:00 PM

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