2018 Policy and Legislative Update February 18, 2018 Aliyah N. Horton, CAE Executive Director Maryland Pharmacists Association

Presentation Overview Policy Highlights Pharmacy-related legislation Legislative and regulatory resources

438th Session – Maryland General Assembly 90 days Nearly 3,000 bills & resolutions ELECTION YEAR! Fun Fact!

Expanded Medication Administration Legislation under development Proposed legislation to expand pharmacists scope to administer a broader range of medications Moves beyond “self-administered” drugs Modifies the statues related to pharmacist immunizations to include injectable medications and biologicals Under a written order or treatment guidelines established by a prescriber

Removing Pharmacist “Gag Order” Legislation under development. PBM may not prohibit a pharmacy or pharmacist from : Providing or discussing with a patient with information regarding the cash price for a prescription drug or the amount of the cost share for which the patient is responsible; or if a more affordable drug is available, selling the more affordable alternative.

Contracts With and Reimbursement of Pharmacists Based on NCPA Model Language MAC LIST Address PBM requirements with respect to multi-source generic pricing updates to pharmacies. Transparency in the methodology and sources for determining the MAC list and all MAC lists used by the PBM for their contract with a pharmacy Time line for updating and disclosing the list as well as eliminating drugs that do not meet the requirements Dispensing fees and other professional fees may not be included in calculations List must be updated every seven days Disclosure requirements if non-parity in MAC lists for medications dispensed in retail vs. mail-order Disclosures to plan sponsor if MAC lists are different between billing the plan sponsor and reimbursing the pharmacy

Contracts With and Reimbursement of Pharmacists (contd.) Standards for Pharmacy Appeals Requires an appeal response within seven days Specific guidance on how to file an appeal publicly available on a website a Denied appeals may be subject to review by the MIA MAC adjustments must be made for all pharmacies in network from effective date of the original claim Automatically apply retroactive reimbursements in next payment cycle Licensing and Enforcement Empowers MIA with new licensing and enforcement provisions that includes all PBM work on behalf of a health benefit plan, state agency, insurer, Medicaid MCO or third-party payors.

Electronic Prescriptions Cost Saving Act Requires dispensers to submit prescription information to the state health information exchange Prohibits Maryland Health Care Commission from imposing fees or assessments MHCC to adopt regulations to specify : specific prescription information to be required for submission time frame for submitting prescription information who may access the prescription information after it is submitted permissible uses of prescription information; and permission information submission requirements that align with data submission requirements of the PDMP.

Medicinal Cannabis Commission Reform Bills introduced to reform cannabis commission to address issues related to: Reduce size of commission Commissioner Transparency (financial and other disclosures) Diversity in licensees and contracts approved by the commission Compassionate use fund MPhA strongly believes a medication and dispensing expert should be on the commission that has an oversight and regulatory role for the industry.

Other Pending Hot Topics E-Prescribing 90-day fill Specialty Drugs DIR Fees

Questions

Legislative and Regulatory Resources Maryland General Assembly http://mgaleg.maryland.gov/ Maryland Code of Regulations http://www.dsd.state.md.us/COMAR/ComarHome.html Fader’s Pharmacy Law Book: Pharmacy Laws and Regulations for the State of Maryland www.marylandpharmacist.org: Resources

Maryland Pharmacists Association Thank you Maryland Pharmacists Association Facebook: /MarylandPharmacistsAssociati on Twitter: @MDPharmacists Website: www.marylandpharmacist.org Aliyah N. Horton, CAE Executive Director Phone: 443-583-8000 Email: Aliyah.Horton@mdpha.com Twitter: @anhorton