Mass. Gen. Laws ch. 176O, § 6. Evidence of coverage to be delivered to covered adults by health, dental and vision care providers; contents: Health Insurance Consumer Protections – Massachusetts
Status: Enacted Year Enacted: 2000
Sets forth the information that carriers must provide to each covered household. See definition section Mass. Gen. Laws ch. 176O, § 1.
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Md. Code, Health-Gen. § 19-108.2. Benchmarks for standardizing and automating process for preauthorizing health care services: Maryland Health Care Commission – Maryland
Status: Enacted Year Enacted: 2012
In addition to the duties stated elsewhere in this subtitle, the Commission shall work with payors and providers to attain benchmarks for standardizing and automating the process required by payors for preauthorizing health care services …
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Md. Code, Health-Gen. §§ 19-101 through 19-111: Maryland Health Care Commission – Maryland
Status: Enacted Year Enacted: 1993
The purpose of the Maryland Health Care Commission includes developing health care cost containment strategies to help provide access to appropriate quality health care services; advocating policies and systems to promote the efficient delivery of …
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Md. Code, Health-Gen. §§ 2-801 through 2-803: Prohibition Against Price Gouging for Essential Off-Patent or Generic Drugs – Maryland
Status: Enacted Year Enacted: 2017
A manufacturer or wholesale distributor may not engage in price gouging in the sale of an essential off-patent or generic drug. It is not a violation of subsection (a) of this section for a wholesale …
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Md. Code, Ins. § 15-112. Powers and Duties of Carriers Relating to Provider Panels: Health Insurance — General Provisions – Maryland
Status: Enacted Year Enacted: 1997
Provides powers and duties of carriers relating to provider panels, regulations for evaluation of network sufficiency of health benefit plans, notification on access to information, arrier reimbursement of group practice at participating provider rate for …
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Md. Code, Ins. § 15-142. Step therapy or fail-first protocols: Health Insurance, General Provisions – Maryland
Status: Enacted Year Enacted: 2014
An entity subject to this section may not impose a step therapy or fail-first protocol on an insured or an enrollee if the step therapy drug has not been approved by the U.S. Food and …
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Md. Code, Ins. §§ 14-601 through 14-612: Discount Medical Plan Organizations and Discount Drug Plan Organizations – Maryland
Status: Enacted Year Enacted: 2007
An entity shall register with the Commissioner as a discount medical plan or drug plan organization before a discount medical plan or drug plan established by that entity is sold, marketed, or solicited in the …
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Md. Code, Ins. §§ 15-101 through 15-143: Health Insurance, General Provisions – Maryland
Status: Enacted Year Enacted: 1997
In accordance with regulations that the Commissioner adopts, the Commissioner shall allow health insurance policies and policies of nonprofit health service plans to contain nonduplication provisions or provisions to coordinate coverage with other health insurance …
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Md. Code, Ins. §§ 15-1604 through 15-1612: Pharmacy Benefits Managers, Part II Registration and Regulation of Pharmacy Benefits Managers – Maryland
Status: Enacted Year Enacted: 2008
A pharmacy benefits manager shall register with the Commissioner as a pharmacy benefits manager before providing pharmacy benefits management services in the State to purchasers. Form of application and fee
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Md. Code, Ins. §§ 15-1628 through 15-1631: Pharmacy Benefits Managers, Part V Contracts with Pharmacies and Pharmacists; Audits – Maryland
Status: Enacted Year Enacted: 2008
At the time of entering into a contract with a pharmacy or a pharmacist, and at least 30 working days before any contract change, a pharmacy benefits manager shall disclose to the pharmacy or pharmacist …
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Md. Code, Ins. §§ 15-1633 through 15-1639: Pharmacy Benefit Managers, Part VI Therapeutic Interchanges – Maryland
Status: Enacted Year Enacted: 2008
In any therapeutic interchange solicitation, the following shall be disclosed to the prescriber: that a therapeutic interchange is being solicited, the circumstances under which the originally prescribed drug will be covered by the purchaser, the …
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Me. Stat. tit. 24-A, § 4303. Plan requirements: Health Plan Requirements – Maine
Status: Enacted Year Enacted: 1995
Prescribes requirements for health plan contracts. Among other things, such as ensuring adequate access to providers, the statute prohibits certain contract provisions including (1) those which induce financial incentives to deny medically necessary services and …
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Me. Stat. tit. 24-A, § 4317. Pharmacy providers: Health Plan Requirements – Maine
Status: Enacted Year Enacted: 2009
Requires health carriers to contract with any pharmacy that meets their terms and conditions for participation in the carrier’s network.
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Mich. Comp. Laws § 400.109h. Prior authorization for certain prescription drugs not required; drugs under contract between department and health maintenance organization; definitions: The Social Welfare Act – Michigan
Status: Enacted Year Enacted: 2004
If the department of community health develops a prior authorization process for prescription drugs as part of the pharmaceutical services offered under the medical assistance program administered under this act, it shall not require prior …
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Mich. Comp. Laws § 400.109l. Process for maximum allowable cost pricing reconsiderations; use by department of community health and contracted health plans; completion; notification to pharmacy: The Social Welfare Act – Michigan
Status: Enacted Year Enacted: 2014
The department of community health and contracted health plans shall utilize a process for maximum allowable cost pricing reconsiderations that must be available and provided to providers and pharmacists.
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Mich. Comp. Laws § 500.2212c. Prescription drug prior authorization workgroup; creation; development of methodology; prior authorization request; definitions: The Insurance Contract – Michigan
Status: Enacted Year Enacted: 2013
On or before January 1, 2015, the workgroup shall develop a standard prior authorization methodology for use by prescribers to request and receive prior authorization from an insurer when a policy, certificate, or contract requires …
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