Address Transparency, Accountability and Oversight of Pharmacy Benefit Managers

Last updated: Jun 2, 2019

Details about this bill
Category: Pharmacy Related
Status: Defeated
Sponsor: Senator Matt Pouliot, Senate 15 - Kennebec County
Session: 129
Bill #: LD 1389




This bill requires that pharmacy benefit managers, which are entities that manage an insurer's prescription drug coverage, be registered by the Department of Health and Human Services. It sets standards for registration including:

1. Allowing the department to revoke, suspend or place on probation a pharmacy benefit manager's registration for fraudulent activities, to protect the safety and interest of a consumer or if the pharmacy benefit manager violates state law;

2. Setting out required pharmacy benefit manager business practices, including:

A. Placing a fiduciary duty on the managers with respect to the insurers who are the managers' clients;
B. Prohibiting the manager from entering into a contract that prohibits a pharmacy or pharmacist from recommending a lower cost or alternative prescription medication than the medication under a covered person's prescription drug plan;
C. Prohibiting the manager from requiring accreditation or certification for a pharmacy inconsistent with, more stringent than or in addition to those required by the Maine Board of Pharmacy and other state and federal authorities;
D. Limiting the amount of payment required by a covered person for a prescription drug at the point of sale; and
E. Prohibiting conflicts of interest; and

3. Requiring an annual report from a pharmacy benefit manager that details the rebates received by the pharmacy benefit manager from pharmaceutical manufacturers for use of the manufacturers' prescription drugs and the disposition of those rebates.