Bill > S830

This bill aims to preserve community pharmacies by introducing detailed regulations for pharmacy services contracts, focusing on fair reimbursement and transparency for pharmacies. The legislation establishes specific guidelines for Pharmacy Benefit Managers (PBMs) regarding drug pricing, reimbursement rates, and audit processes. Key provisions include mandating that pharmacy service contracts use ingredient costs and dispensing fees comparable to the State Medicaid Program, prohibiting retroactive discounts, and creating a structured appeals process for pharmacies challenging drug pricing. The bill defines terms like "brand name drug" and "generic drug" and requires PBMs to frequently update maximum allowable cost lists, provide transparent pricing information, and establish a clear mechanism for pharmacies to contest drug costs. Pharmacies can appeal pricing within seven business days, and if an appeal is valid, the PBM must retroactively adjust costs and reimburse incorrectly paid claims. The Insurance Commissioner is tasked with enforcing these regulations and can conduct audits of PBM practices, with the gathered information remaining confidential. Ultimately, the bill seeks to protect community pharmacies from potentially unfair pricing practices and ensure more equitable compensation for pharmaceutical services.

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https://malegislature.gov/Bills/194/S830