Bill > H1167

This bill establishes comprehensive regulations for pharmacy benefit managers (PBMs), defining their duties and responsibilities in managing prescription drug benefits. The legislation creates a detailed framework that requires PBMs to provide services with care, skill, transparency, and professionalism, prioritizing the interests of enrollees (patients), health benefit plans, and healthcare providers. Key provisions include mandating that PBMs disclose conflicts of interest, provide transparent pricing information, and avoid "spread pricing" (retaining more money than the actual cost of prescription drugs). The bill empowers the state commissioner to adopt regulations defining the specific duties PBMs owe to each stakeholder, with a clear hierarchy that places enrollee interests as the primary consideration. PBMs found in violation of these requirements can face significant penalties, including monetary fines, license suspension, or revocation. The legislation also includes a severability clause ensuring that if any part of the law is found invalid, the rest of the bill remains enforceable. Importantly, the bill applies to any entity providing pharmacy benefit management services, broadly defining such services to include drug pricing negotiation, claims processing, utilization review, and other administrative functions related to prescription drug benefits.

Business and Industry, Health and Social Services

https://malegislature.gov/Bills/194/H1167