Section 15-1612 – Reimbursement for Pharmaceutical Product or Pharmacist Service
(a) This section applies only to a pharmacy benefits manager that provides pharmacy benefits management services on behalf of a carrier. (b) This section does not apply to reimbursement: (1) for specialty drugs; (2) for mail order drugs; or (3) to a chain pharmacy with more than 15 stores or a pharmacist who is an employee of the chain pharmacy. […]
Section 15-1409 – Nonrenewal of Plans
(a) In this section, “product” means a discrete package of health benefits that are offered using a particular product network type within a geographic service area. (b) A carrier that elects not to renew all of a particular product in the State shall: (1) provide notice of the nonrenewal at least 90 days before the date of the […]
Section 15-1613 – In General
A pharmacy and therapeutics committee established by a pharmacy benefits manager performing pharmacy benefits management services on behalf of a carrier shall meet the requirements of this part.
Section 15-1410 – Applicability of Affordable Care Act Provisions
(a) In this section, “plan year” has the meaning stated in § 15–1201 of this title. (b) The guaranteed issuance of coverage provision in Title I, Subtitle C of the Affordable Care Act applies to each health benefit plan with a plan year that begins on or after January 1, 2014.
Section 15-1614 – Composition; Conflict of Interest Statement
(a) (1) A pharmacy and therapeutics committee shall: (i) include clinical specialists that represent the needs of a purchaser’s beneficiaries; and (ii) include at least one practicing pharmacist and one practicing physician who are independent of any developer or manufacturer of prescription drugs. (2) A majority of the members of a pharmacy and therapeutics committee shall be practicing physicians or […]
Section 15-1411 – Disclosure of Aggregate Incurred Claims
(a) (1) In this section the following words have the meanings indicated. (2) “Aggregate incurred claims” means the total claims incurred in the experience period that the carrier uses to experience rate a large employer’s health benefit plan. (3) “Experience rating” means that a carrier develops the premium rates for an employer’s health benefit plan based in whole or […]
Section 15-1615 – Mandatory Participation on Committee Prohibited
A pharmacy benefits manager may not require a pharmacist to participate on its pharmacy and therapeutics committee.
Section 15-1501 – Mandated Health Insurance Services
(a) (1) In this subtitle the following words have the meanings indicated. (2) “Commission” means the Maryland Health Care Commission. (3) (i) “Mandated health insurance service” means a legislative proposal or statute that would require a particular health care service to be provided or offered in a health benefit plan, by a carrier, including a health maintenance organization, or other […]
Section 15-1616 – Disclosure About Composition
On request of a purchaser for which the pharmacy and therapeutics committee makes recommendations, a pharmacy benefits manager shall disclose information about the composition of its pharmacy and therapeutics committee to the purchaser.
Section 15-1502 – Evaluation of Mandated Health Insurance Services
(a) (1) The Commission shall conduct an evaluation of existing mandated health insurance services and make recommendations to the General Assembly regarding decision making criteria for reducing the number of mandates or the extent of coverage. (2) The evaluation shall include: (i) an assessment of the full cost of each existing mandated health insurance service as a percentage of […]