§ 15-130

Maryland § 15-130

• Jurisdiction: Maryland
• Article gin: Insurance
• Title: 15

Text

(a) (1) This section applies to:

(i) insurers and nonprofit health service plans that provide coverage for prescription drugs on an outpatient basis under health insurance policies or contracts that are issued or delivered in the State;

(ii) health maintenance organizations that provide coverage for prescription drugs on an outpatient basis under contracts that are issued or delivered in the State;

(iii) managed care organizations, as defined in § 15–101 of the Health – General Article, that provide coverage for prescription drugs on an outpatient basis under contracts that are issued or delivered in the State; and

(iv) to the extent consistent with State and federal law, third party administrators.

(2) This section does not apply to:

(i) short–term travel or accident–only policies;

(ii) short–term nonrenewable policies of not more than 3 months duration; or

(iii) any health maintenance organization that operates or maintains its own pharmacies and dispenses, on an annual basis, over 95% of prescription drugs on an outpatient basis to its enrollees at its own pharmacies.

(b) Each entity subject to this section shall provide to its insureds, subscribers, or enrollees a health insurance benefit card, prescription benefit card, or other technology that:

(1) (i) complies with the standards set forth in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide in effect at the time of issuance of the card or other technology; or

(ii) includes, at a minimum, the following data elements:

1. the name or identifying trademark of the entity subject to this section or, if another entity administers the prescription benefit, the name or identifying trademark of the benefit administrator;

2. the name and identification number of the insured, subscriber, or enrollee;

3. the telephone number that providers may call for pharmacy benefit assistance; and

4. all electronic transaction routing information and other numbers required by the entity subject to this section or benefit administrator to process a prescription claim electronically; and

(2) indicates which State agency regulates, in whole or in part, the policy or contract offered by the entity by:

(i) for an entity subject to the Administration, displaying “MIA” prominently; or

(ii) for an entity subject to the Maryland Department of Health, displaying “MDH” prominently.

(c) If an entity subject to this section contracts with or otherwise arranges for the prescription benefit to be administered by another subsidiary or entity, including a pharmacy benefit manager, the entity subject to this section shall require the benefit administrator to comply with this section.

(d) (1) The health insurance benefit card, prescription benefit card, or other technology shall be issued to each insured, subscriber, or enrollee by an entity subject to this section.

(2) If a change occurs in any of the data elements required under subsection (b)(1)(ii) of this section, an entity subject to this section shall:

(i) reissue a health insurance benefit card, prescription drug benefit card, or other technology; or

(ii) provide the insured, subscriber, or enrollee with the corrective information necessary to electronically process a prescription claim.

(e) An entity subject to this section may comply with this section by issuing to each insured, subscriber, or enrollee a health insurance benefit card that contains data elements related to both prescription and nonprescription health insurance benefits.

(f) The Maryland Department of Health shall adopt regulations to enable managed care organizations to comply with:

(1) the requirements of this section; and

(2) any unique requirements of the HealthChoice Program that relate to the electronic processing of claims.