Bill > H1325

This bill establishes new regulations for pharmacy benefits managers (PBMs) and their maximum allowable cost (MAC) lists for generic medications, aimed at ensuring fair pricing and transparency. The bill defines a MAC list as a pricing mechanism that sets the maximum reimbursement amount for drugs, and requires that drugs on these lists meet specific FDA criteria, such as being "A" or "AB" rated in the Orange Book and having at least two therapeutically equivalent alternatives available. PBMs must update their MAC lists every three business days, ensure the costs are at or above pharmacies' acquisition costs, and make these lists readily accessible to contracted pharmacies. The bill creates a formal appeals process for pharmacies to contest MAC prices, allowing them to file appeals within seven business days if they believe the set price is below the drug's actual market cost. If a pharmacy's appeal is validated, the PBM must adjust the MAC for that drug across its entire network within three business days. Additionally, the bill protects pharmacists' rights to discuss treatment alternatives and cost information with patients and prohibits PBMs from penalizing pharmacies for providing such transparency. The Insurance Commissioner is granted enforcement authority, with the ability to examine PBM records while maintaining the confidentiality of proprietary information.

Business and Industry

https://malegislature.gov/Bills/194/H1325