Maryland HB 1376: Pharmacy Benefits - Processing and Adjudication of Claims - Restrictions on Fees

Bill Text

EXPLANATION: CAPITALS INDICATE MATTER ADDED TO EXISTING LAW.
[Brackets] indicate matter deleted from existing law.
*hb1376*

HOUSE BILL 1376
C3 8lr2659
HB 1162/17 – HGO CF SB 1077
By: Delegates Morgan, Anderton, Carozza, Ghrist, Mautz, Otto, and
Sample–Hughes
Introduced and read first time: February 9, 2018
Assigned to: Health and Government Operations

A BILL ENTITLED

AN ACT concerning 1

Pharmacy Benefits – Processing and Adjudication of Claims – Restrictions on 2
Fees 3

FOR the purpose of prohibiting pharmacy benefits managers or certain purchasers from 4
directly or indirectly charging a contracted pharmacy, or holding a contracted 5
pharmacy responsible for, certain fees; defining a certain term; and generally 6
relating to pharmacy benefits, fees, and the processing and adjudication of claims. 7

BY adding to 8
Article – Insurance 9
Section 15–1628.2 10
Annotated Code of Maryland 11
(2017 Replacement Volume) 12

SECTION 1. BE IT ENACTED BY THE GENERAL ASSEMBLY OF MARYLAND, 13
That the Laws of Maryland read as follows: 14

Article – Insurance 15

15–1628.2. 16

(A) IN THIS SECTION, “CONTRACTED PHARMACY” HAS THE MEANING 17
STATED IN § 15–1628.1 OF THIS SUBTITLE. 18

(B) A PHARMACY BENEFITS MANAGER OR A PURCHASER MAY NOT 19
DIRECTLY OR INDIRECTLY CHARGE A CONTRACTED PHARMACY, OR HOLD A 20
CONTRACTED PHARMACY RESPONSIBLE FOR, A FEE RELATED TO A CLAIM THAT IS 21
NOT: 22

2 HOUSE BILL 1376

(1) SPECIFICALLY ENUMERATED BY THE PHARMACY BENEFITS 1
MANAGER OR PURCHASER AT THE TIME OF CLAIM PROCESSING; OR 2

(2) REPORTED ON THE INITIAL REMITTANCE ADVICE OF AN 3
ADJUDICATED CLAIM. 4

SECTION 2. AND BE IT FURTHER ENACTED, That this Act shall take effect 5
October 1, 2018. 6