Bill > S687

This bill aims to ensure fair and reasonable pharmacy networks by introducing several key provisions. It defines "steering" as a practice where a pharmacy benefit manager (PBM) or carrier directs prescriptions to pharmacies in which they have an ownership interest, such as retail, mail-order, or specialty pharmacies. The bill requires PBMs to maintain a reasonably adequate and accessible network of pharmacies that provides convenient patient access within a reasonable distance from patients' residences. It also prohibits PBMs from denying a pharmacy preferred network participation status if the pharmacy is willing to accept the same terms and conditions as other pharmacies, and specifically excludes mail-order pharmacies from network adequacy calculations. To discourage steering practices, the bill imposes a 10 percent surcharge on PBMs and health plans that engage in steering, with the surcharge calculated based on the aggregate reimbursement amount for prescription drugs in the previous calendar year. These provisions are designed to promote fair competition among pharmacies, increase patient access to pharmacy services, and prevent PBMs from unfairly directing prescription business to their own pharmacies.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/S687