MARYLAND MOVES TO REGULATE PBMs

JUNE 01, 2008

Maryland will become the first state in the nation to enact a comprehensive plan to regulate the business of pharmacy benefit managers (PBMs). Among provisions included in a series of bills approved by the state legislature in April, PBMs will have to register with the state, disclose certain information before switching a prescription, and provide fee schedule information to pharmacies.

"This comprehensive plan to regulate these entities that manage many of our prescriptions helps ensure that consumers and the health care market are treated fairly and able to make informed decisions," noted the state?s insurance commissioner, Ralph S. Tyler.

Under the new legislation, PBMs will have to register with the Maryland Insurance Administration and must ensure that the individuals making decisions about the medications on the PBM?s formulary lists have appropriate credentials. The legislation also requires PBMs to have an internal appeals process available for pharmacies when there is a denial of payment.

"The passage of these bills recognizes the important issues highlighted in the settlements entered into by my office," said Maryland Attorney General Douglas Ganzler.



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