HF 2195 (see companion bill SF 2111) – Minnesota
Introduced: 2021 Status: Inactive / Dead
Health carriers allowed to offer reference-based pricing health plans.
HF 2824 (see companion bill SF 2814) – Minnesota
Introduced: 2019 Status: Inactive / Dead
Health carrier authorized to offer reference-based pricing health plan in individual and small group markets.
HJ 65 – Montana
Introduced: 2019 Status: Inactive / Dead
Interim study of reference-based pricing in insurance plans. That the Legislative Council be requested to designate an appropriate interim committee, pursuant to section 5-5-217, MCA, to study the effects of reference-based pricing on health care …
LD 1504 – Maine
Introduced: 2019 Status: Enacted
This bill replaces the current registration requirement for pharmacy benefits managers doing business in this State with a licensing requirement beginning January 1, 2020. The bill imposes the following requirements on a carrier that provides …
LD 1816 – Maine
Introduced: 2023 Status: In Process
This bill requires that a state entity, health plan or participating plan qualified under the federal Employee Retirement Income Security Act of 1974 may not purchase prescription drugs to be dispensed or delivered to a …
LD 1829 – Maine
Introduced: 2023 Status: In Process
This bill requires that a state entity, health plan or participating plan qualified under the federal Employee Retirement Income Security Act of 1974 may not purchase prescription drugs to be dispensed or delivered to a …
Md. Code, Ins. § 14-205. Benefits for health care services; payments and rates for providers: Preferred Provider Organizations – Maryland
Status: Enacted Year Enacted: 1997
Services rendered by preferred providers may be compensated either through direct payments to the health care provider or through reimbursement to the insured. PPOs must also pay a reasonable amount of compensation as determined by …
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Md. Code, Ins. § 14-205.1. Policies which condition payment on the use of preferred providers: Preferred Provider Organizations – Maryland
Status: Enacted Year Enacted: 2007
The Commissioner may authorize an insurer or nonprofit health service plan to offer a preferred provider insurance policy that conditions the payment of benefits on the use of preferred providers if the insurer or nonprofit …
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Md. Code, Ins. § 14-205.2. Payments to on-call physicians and hospital-based physicians: Preferred Provider Organizations – Maryland
Status: Enacted Year Enacted: 2010
Except as provided in subsection (3), an insured may not be liable to an on-call physician or a hospital-based physician subject to this section for covered services rendered by the on- call physician or hospital-based …
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Md. Code, Ins. §§ 14-201 through 14-206: Preferred Provider Organizations – Maryland
Status: Enacted Year Enacted: 1997
Insurers may an insurer may offer preferred provider insurance policies that limit, through the use of provider service contracts, the numbers and types of providers of health care services eligible for payment as preferred providers, …
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Minn. Stat. §§ 151.01; 151.21 – Minnesota
Status: Enacted
Requires a pharmacist to substitute a biological similar drug if a less expensive one is available as long as the patient has not expressly indicated as otherwise.
Mont. Code Ann. § 33-22-170. Definitions: Disability Insurance General Provisions – Montana
Status: Enacted Year Enacted: 2015
Definitions for reference pricing in Montana for Disability Insurance.
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Mont. Code Ann. § 33-22-171. Maximum allowable cost list — limitations on drugs: Disability Insurance General Provisions – Montana
Status: Enacted Year Enacted: 2015
Specifications for a drug before a pharmacy benefit manager places or continues it on a maximum allowable cost list.
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Mont. Code Ann. § 33-22-172. Maximum allowable cost or reference price list — price formulation, updating, and disclosure — exceptions: Disability Insurance General Provisions – Montana
Status: Enacted Year Enacted: 2015
At the time it enters into a contract with a pharmacy and subsequently upon request, a plan sponsor, health insurance issuer, or pharmacy benefit manager shall provide the pharmacy with the sources used to determine …
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Mont. Code Ann. § 33-22-173. Maximum allowable cost or reference price list — appeals process: Disability Insurance General Provisions – Montana
Status: Enacted Year Enacted: 2015
If the final determination is a denial of the pharmacy’s appeal, the pharmacy benefit manager shall state the reason for the denial and provide the national drug code of an equivalent drug that is available …
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Mont. Code Ann. § 33-22-174. Opt-out of reference pricing — notification: Disability Insurance General Provisions – Montana
Status: Enacted Year Enacted: 2017
Pharmacists or pharmacies in a network plan on referenced based pricing may decline to provide a brand-namedrug, multisource generic drug, supply, or service if the reference pricing amount is less than the acquisition cost paid …
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