§ 19-108.5
563 words·~3 min read·
/md/health-general/19-108-5·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§19–108.5.
(1)In this section the following words have the meanings indicated.
(2)“Carrier” has the meaning stated in § 15–1301 of the Insurance Article.
(3)“Health care provider” has the meaning stated in § 19–108.3 of this subtitle.
(1)On or before July 1, 2026, a carrier shall establish and maintain an online process that:
(i)Links directly to all e–prescribing systems and electronic health record systems that use the National Council for Prescription Drug Programs SCRIPT standard and the National Council for Prescription Drug Programs Real Time Benefit Standard;
(ii)Can accept electronic prior authorization requests from a health care provider;
(iii)Can approve electronic prior authorization requests:
1. For which no additional information is needed by the carrier to process the prior authorization request;
2. For which no clinical review is required; and
3. That meet the carrier’s criteria for approval; and
(iv)Links directly to real–time patient out–of–pocket costs, including copayment, deductible, and coinsurance costs, and more affordable medication alternatives made available by the carrier.
(2)A carrier may not:
(i)Impose a fee or charge on a person for accessing the online process required under paragraph
(1)of this subsection; or
(ii)Access, without health care provider consent, health care provider data via the online process other than for the insured or enrollee.
(c)On or before July 1, 2025, a carrier shall:
(1)On request of a health care provider, provide contact information for each third–party vendor or other entity that the carrier will use to meet the requirements of subsection
(b)of this section; and
(2)Post the contact information required to be provided under item
(1)of this subsection on its website.
(1)On or before July 1, 2026, each health care provider shall ensure that each e–prescribing system or electronic health record system owned or contracted for by the health care provider to maintain a health record of an insured or enrollee has the ability to access, at the point of prescribing:
(i)The electronic prior authorization process established by a carrier under subsection
(b)of this section; and
(ii)The real–time patient out–of–pocket cost information and available medication alternatives required under subsection
(b)of this section.
(2)The Commission shall establish by regulation a process through which a health care provider may request and receive a waiver of compliance from the requirements of this subsection.
(1)On or before July 1, 2026, each carrier, or a pharmacy benefits manager on behalf of the carrier, shall:
(i)Provide real–time patient–specific benefit information to insureds and enrollees and contracted health care providers, including any out–of–pocket costs and more affordable medication alternatives or prior authorization requirements; and
(ii)Ensure that the information provided under item
(i)of this paragraph is accurate.
(2)Each carrier, or a pharmacy benefits manager on behalf of the carrier, shall make available the information required to be provided under paragraph
(1)of this subsection to the health care provider at the point of prescribing in an accessible and understandable format, such as through the health care provider’s e–prescribing system or electronic health record system that the carrier, pharmacy benefits manager, or designated subcontractor has adopted that uses the National Council for Prescription Drug Programs SCRIPT standard and the National Council for Prescription Drug Programs Real Time Benefit Standard from which the health care provider makes the request.