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Maryland Code, Insurance § 15-822.1

Current as of January 01, 2025 | Updated by Findlaw Staff

(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.

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Cite this article: FindLaw.com - Maryland Code, Insurance § 15-822.1 - last updated January 01, 2025 | https://codes.findlaw.com/md/insurance/md-code-insurance-sect-15-822-1/

FindLaw Codes may not reflect the most recent version of the law in your jurisdiction. Please verify the status of the code you are researching with the state legislature before relying on it for your legal needs.

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