This bill aims to regulate how pharmacy benefits managers (PBMs) operate in regards to specialty drugs. PBMs are companies that manage prescription drug benefits on behalf of health insurers. The bill prohibits PBMs from requiring beneficiaries to use a specific pharmacy or entity for a specialty drug if the drug is dispensed by a physician for a chronic, complex, rare, or life-threatening condition and meets certain criteria. It also prevents PBMs from reimbursing a pharmacy or pharmacist in an amount less than what the PBM itself or an affiliate gets for the same product [...]

This bill amends the reimbursement levels for drug products that the Maryland Medical Assistance Program (a state-funded health insurance program for low-income residents) is required to establish. This also applies to pharmacy benefit managers that contract with a pharmacy on behalf of a managed care organization. The reimbursement level will be at least equal to the national average drug acquisition cost of the generic product plus the fee-for-service professional dispensing fee. The bill also broadens the definition of a "purchaser" in laws regulating pharmacy benefits managers to include certain insurers, nonprofit health service plans, [...]