Bill > H1202

This bill aims to ensure access to generic medications by regulating the practices of pharmacy benefit managers (PBMs) and covered entities. The key provisions include: 1. Requiring PBMs and covered entities to only place drugs on a "maximum allowable cost list" (a list of drugs with a maximum reimbursement amount) if the drugs have an "A" or "AB" rating from the FDA's Orange Book, and there are at least two therapeutically equivalent, multiple-source drugs or one generic drug available. 2. Mandating that PBMs and covered entities remove drugs from the maximum allowable cost list within 3 business days if the drugs no longer meet the requirements. 3. Obligating PBMs and covered entities to provide pharmacies with the sources used to determine the maximum allowable costs, the maximum allowable costs for individual drugs, and the maximum allowable cost lists upon request. 4. Requiring PBMs and covered entities to ensure the maximum allowable cost is equal to or greater than the pharmacy's acquisition cost and update the lists at least every 3 business days. 5. Establishing a process for pharmacies to contest the listed maximum allowable cost for a particular drug or medical product, with the PBM or covered entity required to provide a final determination within 7 business days. 6. Empowering the Insurance Commissioner to enforce the act and examine or audit the books and records of PBMs to ensure compliance.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/192/H1202