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 […]
Section 15-1601 – Definitions
(a) In this subtitle the following words have the meanings indicated. (b) “Agent” means a pharmacy, a pharmacist, a mail order pharmacy, or a nonresident pharmacy acting on behalf or at the direction of a pharmacy benefits manager. (c) “Beneficiary” means an individual who receives prescription drug coverage or benefits from a purchaser. (d) (1) “Carrier” means the State Employee […]
Section 15-1604 – Registration
(a) A pharmacy benefits manager shall register with the Commissioner as a pharmacy benefits manager before providing pharmacy benefits management services in the State to purchasers. (b) An applicant for registration shall: (1) file with the Commissioner an application on the form that the Commissioner provides; and (2) pay to the Commissioner a registration fee set by the Commissioner. […]
Section 15-1605 – Expiration; Renewal
(a) A pharmacy benefits manager registration expires on the second September 30 after its effective date unless it is renewed as provided under this section. (b) A pharmacy benefits manager may renew its registration for an additional 2–year term, if the pharmacy benefits manager: (1) otherwise is entitled to be registered; (2) files with the Commissioner a renewal application […]