§ 15-822.1

Maryland § 15-822.1

• 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 and devices to individuals or groups under health insurance policies or contracts that are delivered in the State; and

(ii) health maintenance organizations that provide coverage for prescription drugs and devices to individuals or groups under contracts that are issued or delivered in the State.

(2) An insurer, a nonprofit health service plan, or a health maintenance organization that provides coverage for prescription drugs and devices through a pharmacy benefits manager is subject to the requirements of this section.

(b) An entity subject to this section shall limit the amount a covered individual is required to pay in copayments or coinsurance for a covered prescription insulin drug to not more than $30 for a 30–day supply, regardless of the amount or type of insulin needed to fill the covered individual’s prescription.

(c) An entity subject to this section may set the amount a covered individual is required to pay to an amount that is less than the payment amount limit under subsection (b) of this section.

(d) A contract between an entity subject to this section, or a pharmacy benefits manager through which the entity provides coverage for prescription drugs and devices, and a pharmacy or the pharmacy’s contracting agent, may not:

(1) authorize a party to the contract to charge a covered individual an amount that is more than the payment amount limit under subsection (b) of this section;

(2) require a pharmacy to collect from a covered individual an amount that is more than the payment amount limit under subsection (b) of this section; or

(3) require a covered individual to pay an amount that is more than the payment amount limit under subsection (b) of this section.