Legislation
SECTION 2904
Reporting requirements for pharmacy benefit managers
Insurance (ISC) CHAPTER 28, ARTICLE 29
§ 2904. Reporting requirements for pharmacy benefit managers. (a)
* (1) On or before July first of each year, every pharmacy benefit
manager shall report to the superintendent, in a statement subscribed
and affirmed as true under penalties of perjury, the information
requested by the superintendent including, without limitation,
(i) any pricing discounts, rebates of any kind, inflationary payments,
credits, clawbacks, fees, grants, chargebacks, reimbursements, other
financial or other reimbursements, incentives, inducements, refunds or
other benefits received by the pharmacy benefit manager; and
(ii) the terms and conditions of any contract or arrangement,
including other financial or other reimbursements incentives,
inducements or refunds between the pharmacy benefit manager and any
other party relating to pharmacy benefit management services provided to
a health plan including but not limited to, dispensing fees paid to
pharmacies.
* NB Effective until November 5, 2025
* (1) (i) On or before July first of each year, every pharmacy benefit
manager shall report to the superintendent, in a statement subscribed
and affirmed as true under penalties of perjury, the information
requested by the superintendent including, without limitation,
(A) any pricing discounts, rebates of any kind, inflationary payments,
credits, clawbacks, fees, grants, chargebacks, reimbursements, other
financial or other reimbursements, incentives, inducements, refunds or
other benefits received by the pharmacy benefit manager;
(B) the terms and conditions of any contract or arrangement, including
other financial or other reimbursements incentives, inducements or
refunds between the pharmacy benefit manager and any other party
relating to pharmacy benefit management services provided to a health
plan including but not limited to, dispensing fees paid to pharmacies;
(C) the aggregated dollar amount of rebates, fees, price protection
payments and any other payments the pharmacy benefit manager received
from drug manufacturers through rebate contracts;
(D) the portions of the amount in clause (C) of this subparagraph
which were:
1. passed on to health plans; or
2. retained by the pharmacy benefit manager; and
(E) for each rebate contract in effect during the reporting period:
1. the names of the contracting parties;
2. the execution date and the term of the contract, including
extensions;
3. the name of the drugs and the associated national drug codes
covered by the rebate contract, and for each drug:
(I) a summary of the contract terms regarding formulary placement,
formulary exclusion, or prior authorization requirements or step edits,
of any drugs considered to compete with each drug;
(II) a summary of all terms requiring or incentivizing volume or
market share for each drug, including base rebate amounts, bundled
rebates and incremental rebates, stated separately, and price
concession, stated separately for each drug; and
(III) the total number of prescriptions filled and units dispensed for
which a rebate, discount, price concession or other consideration was
received by the pharmacy benefit manager for each drug;
4. the rebate percentage and dollar amount retained by the pharmacy
benefit manager for every rebate, discount, price concession or other
consideration under each rebate contract; and
5. the dollar amount of any other compensation paid by a drug
manufacturer to a pharmacy benefit manager for services including
distribution management services, data or data services, marketing or
promotional services, research programs, or other ancillary services,
under each rebate contract.
(ii) For the purposes of this subsection, the term "rebate contract"
means any agreement entered into by a pharmacy benefit manager with any
drug manufacturer or agent or affiliate of a drug manufacturer that
determines any rebate, discount, administrative or other fee, price
concession, or other consideration related to the dispensing of
prescription drugs for a health plan.
* NB Effective November 5, 2025
(2) The superintendent may require the filing of quarterly or other
statements, which shall be in such form and shall contain such matters
as the superintendent shall prescribe.
(3) The superintendent may address to any pharmacy benefit manager or
its officers any inquiry in relation to its provision of pharmacy
benefit management services or any matter connected therewith. Every
pharmacy benefit manager or person so addressed shall reply in writing
to such inquiry promptly and truthfully, and such reply shall be, if
required by the superintendent, subscribed by such individual, or by
such officer or officers of the pharmacy benefit manager, as the
superintendent shall designate, and affirmed by them as true under the
penalties of perjury.
(b) In the event any pharmacy benefit manager or person does not
submit the report required by paragraph one of subsection (a) of this
section or does not provide a good faith response to an inquiry from the
superintendent pursuant to paragraph three of subsection (a) of this
section within a time period specified by the superintendent of not less
than fifteen business days, the superintendent is authorized to levy a
civil penalty, after notice and hearing, against such pharmacy benefit
manager or person not to exceed four thousand dollars per day for each
day beyond the date the report is due or the date specified by the
superintendent for response to the inquiry.
(c) All information, documents and material disclosed by a pharmacy
benefit manager under this section and in the possession or under
control of the superintendent shall be deemed confidential and not
subject to disclosure except where and as the superintendent determines
that disclosure is in the public interest. This subsection shall not
apply to information, documents and materials where they are in the
possession and under the control of a person or entity other than the
superintendent.
* (1) On or before July first of each year, every pharmacy benefit
manager shall report to the superintendent, in a statement subscribed
and affirmed as true under penalties of perjury, the information
requested by the superintendent including, without limitation,
(i) any pricing discounts, rebates of any kind, inflationary payments,
credits, clawbacks, fees, grants, chargebacks, reimbursements, other
financial or other reimbursements, incentives, inducements, refunds or
other benefits received by the pharmacy benefit manager; and
(ii) the terms and conditions of any contract or arrangement,
including other financial or other reimbursements incentives,
inducements or refunds between the pharmacy benefit manager and any
other party relating to pharmacy benefit management services provided to
a health plan including but not limited to, dispensing fees paid to
pharmacies.
* NB Effective until November 5, 2025
* (1) (i) On or before July first of each year, every pharmacy benefit
manager shall report to the superintendent, in a statement subscribed
and affirmed as true under penalties of perjury, the information
requested by the superintendent including, without limitation,
(A) any pricing discounts, rebates of any kind, inflationary payments,
credits, clawbacks, fees, grants, chargebacks, reimbursements, other
financial or other reimbursements, incentives, inducements, refunds or
other benefits received by the pharmacy benefit manager;
(B) the terms and conditions of any contract or arrangement, including
other financial or other reimbursements incentives, inducements or
refunds between the pharmacy benefit manager and any other party
relating to pharmacy benefit management services provided to a health
plan including but not limited to, dispensing fees paid to pharmacies;
(C) the aggregated dollar amount of rebates, fees, price protection
payments and any other payments the pharmacy benefit manager received
from drug manufacturers through rebate contracts;
(D) the portions of the amount in clause (C) of this subparagraph
which were:
1. passed on to health plans; or
2. retained by the pharmacy benefit manager; and
(E) for each rebate contract in effect during the reporting period:
1. the names of the contracting parties;
2. the execution date and the term of the contract, including
extensions;
3. the name of the drugs and the associated national drug codes
covered by the rebate contract, and for each drug:
(I) a summary of the contract terms regarding formulary placement,
formulary exclusion, or prior authorization requirements or step edits,
of any drugs considered to compete with each drug;
(II) a summary of all terms requiring or incentivizing volume or
market share for each drug, including base rebate amounts, bundled
rebates and incremental rebates, stated separately, and price
concession, stated separately for each drug; and
(III) the total number of prescriptions filled and units dispensed for
which a rebate, discount, price concession or other consideration was
received by the pharmacy benefit manager for each drug;
4. the rebate percentage and dollar amount retained by the pharmacy
benefit manager for every rebate, discount, price concession or other
consideration under each rebate contract; and
5. the dollar amount of any other compensation paid by a drug
manufacturer to a pharmacy benefit manager for services including
distribution management services, data or data services, marketing or
promotional services, research programs, or other ancillary services,
under each rebate contract.
(ii) For the purposes of this subsection, the term "rebate contract"
means any agreement entered into by a pharmacy benefit manager with any
drug manufacturer or agent or affiliate of a drug manufacturer that
determines any rebate, discount, administrative or other fee, price
concession, or other consideration related to the dispensing of
prescription drugs for a health plan.
* NB Effective November 5, 2025
(2) The superintendent may require the filing of quarterly or other
statements, which shall be in such form and shall contain such matters
as the superintendent shall prescribe.
(3) The superintendent may address to any pharmacy benefit manager or
its officers any inquiry in relation to its provision of pharmacy
benefit management services or any matter connected therewith. Every
pharmacy benefit manager or person so addressed shall reply in writing
to such inquiry promptly and truthfully, and such reply shall be, if
required by the superintendent, subscribed by such individual, or by
such officer or officers of the pharmacy benefit manager, as the
superintendent shall designate, and affirmed by them as true under the
penalties of perjury.
(b) In the event any pharmacy benefit manager or person does not
submit the report required by paragraph one of subsection (a) of this
section or does not provide a good faith response to an inquiry from the
superintendent pursuant to paragraph three of subsection (a) of this
section within a time period specified by the superintendent of not less
than fifteen business days, the superintendent is authorized to levy a
civil penalty, after notice and hearing, against such pharmacy benefit
manager or person not to exceed four thousand dollars per day for each
day beyond the date the report is due or the date specified by the
superintendent for response to the inquiry.
(c) All information, documents and material disclosed by a pharmacy
benefit manager under this section and in the possession or under
control of the superintendent shall be deemed confidential and not
subject to disclosure except where and as the superintendent determines
that disclosure is in the public interest. This subsection shall not
apply to information, documents and materials where they are in the
possession and under the control of a person or entity other than the
superintendent.