§ 15-1611.2
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/md/insurance/15-1611-2A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–1611.2.
(1)In this section the following words have the meanings indicated.
(2)“Covered entity” has the meaning stated in § 602 of the federal Veterans Health Care Act of 1992.
(3)“Pharmacies or pharmacists that participate in the 340B Program” means:
(i)a pharmacy owned or operated by a covered entity that is eligible to or is actively participating in the 340B Program; or
(ii)a pharmacy or pharmacist under contract with a covered entity to dispense drugs purchased under the 340B Program to patients of the covered entity.
(4)“340B Program” means the drug pricing program established under § 602 of the federal Veterans Health Care Act of 1992.
(b)A pharmacy benefits manager shall:
(1)make formulary and coverage decisions for a pharmacy or pharmacist that participates in the 340B Program based on the normal course of business of the pharmacy benefits manager; and
(2)allow a beneficiary to use any in–network pharmacy or pharmacist that the beneficiary chooses, without regard to whether the pharmacy or pharmacist participates in the 340B Program.
(c)A pharmacy benefits manager may not:
(1)transfer 340B Program savings from a pharmacy or pharmacist that participates in the 340B Program to a pharmacy benefits manager;
(2)offer lower reimbursement for a prescription drug purchased under the 340B Program than the reimbursement it offers for the same prescription drug if it is not purchased under the 340B Program;
(3)refuse to cover prescription drugs purchased under the 340B Program;
(4)refuse to allow pharmacies or pharmacists that participate in the 340B Program to participate in the pharmacy benefits manager’s network on the sole basis that the pharmacy or pharmacist participates in the 340B Program;
(5)impose different reimbursement or network participation contract terms on pharmacies or pharmacists that participate in a pharmacy benefits manager’s network based on whether a pharmacy or pharmacist participates in the 340B Program;
(6)impose different fees, chargebacks, or other adjustments on pharmacies or pharmacists based on whether a pharmacy or pharmacist participates in the 340B Program;
(7)modify a beneficiary’s copayment on the basis of whether a pharmacy or pharmacist participates in the 340B Program;
(8)establish or set network adequacy requirements based on whether a pharmacy or pharmacist participates in the 340B Program; or
(9)prohibit a covered entity authorized to participate in the 340B Program or a pharmacy or pharmacist under contract with a covered entity authorized to participate in the 340B Program from participating in the pharmacy benefits manager’s network on the basis of the covered entity’s participation in the 340B Program.
(d)A pharmacy benefits manager may not base formulary or prescription drug coverage decisions on:
(1)the price of the prescription drug under the 340B Program; or
(2)whether the dispensing pharmacy or pharmacist participates in the 340B Program.