§ 15-1601. Definitions.

   (a) In general. -- In this subtitle the following words have the meanings indicated.

(b) Agent. -- "Agent" means a pharmacy, a pharmacist, a mail order pharmacy, or a nonresident pharmacy acting on behalf or at the direction of a pharmacy benefits manager.

(c) Beneficiary. -- "Beneficiary" means an individual who receives prescription drug coverage or benefits from a purchaser.

(d) ERISA. -- "ERISA" has the meaning stated in § 8-301 of this article.

(e) Formulary. -- "Formulary" means a list of prescription drugs used by a purchaser.

(f) Manufacturer payments. --

   (1) "Manufacturer payments" means any compensation or remuneration a pharmacy benefits manager receives from or on behalf of a pharmaceutical manufacturer.

   (2) "Manufacturer payments" includes:

      (i) payments received in accordance with agreements with pharmaceutical manufacturers for formulary placement and, if applicable, drug utilization;

      (ii) rebates, regardless of how categorized;

      (iii) market share incentives;

      (iv) commissions;

      (v) fees under products and services agreements;

      (vi) any fees received for the sale of utilization data to a pharmaceutical manufacturer; and

      (vii) administrative or management fees.

   (3) "Manufacturer payments" does not include purchase discounts based on invoiced purchase terms.

(g) Nonprofit health maintenance organization. -- "Nonprofit health maintenance organization" has the meaning stated in § 6-121(a) of this article.

(h) Nonresident pharmacy. -- "Nonresident pharmacy" has the meaning stated in § 12-403 of the Health Occupations Article.

(i) Pharmacist. -- "Pharmacist" has the meaning stated in § 12-101 of the Health Occupations Article.

(j) Pharmacy. -- "Pharmacy" has the meaning stated in § 12-101 of the Health Occupations Article.

(k) Pharmacy and therapeutics committee. -- "Pharmacy and therapeutics committee" means a committee established by a pharmacy benefits manager to:

   (1) objectively appraise and evaluate prescription drugs; and

   (2) make recommendations to a purchaser regarding the selection of drugs for the purchaser's formulary.

(l) Pharmacy benefits management services. --

   (1) "Pharmacy benefits management services" means:

      (i) the procurement of prescription drugs at a negotiated rate for dispensation within the State to beneficiaries;

      (ii) the administration or management of prescription drug coverage provided by a purchaser for beneficiaries; and

      (iii) any of the following services provided with regard to the administration of prescription drug coverage:

         1. mail service pharmacy;

         2. claims processing, retail network management, and payment of claims to pharmacies for prescription drugs dispensed to beneficiaries;

         3. clinical formulary development and management services;

         4. rebate contracting and administration;

         5. patient compliance, therapeutic intervention, and generic substitution programs; or

         6. disease management programs.

   (2) "Pharmacy benefits management services" does not include any service provided by a nonprofit health maintenance organization that operates as a group model, provided that the service:

      (i) is provided solely to a member of the nonprofit health maintenance organization; and

      (ii) is furnished through the internal pharmacy operations of the nonprofit health maintenance organization.

(m) Pharmacy benefits manager. -- "Pharmacy benefits manager" means a person that performs pharmacy benefits management services.

(n) Proprietary information. -- "Proprietary information" means:

   (1) a trade secret;

   (2) confidential commercial information; or

   (3) confidential financial information.

(o) Purchaser. --

   (1) "Purchaser" means the State Employee and Retiree Health and Welfare Benefits Program, an insurer, a nonprofit health service plan, or a health maintenance organization that:

      (i) provides prescription drug coverage or benefits in the State; and

      (ii) enters into an agreement with a pharmacy benefits manager for the provision of pharmacy benefits management services.

   (2) "Purchaser" does not include a person that provides prescription drug coverage or benefits through plans subject to ERISA and does not provide prescription drug coverage or benefits through insurance, unless the person is a multiple employer welfare arrangement as defined in § 514(b)(6)(a)(ii) of ERISA.

(p) Rebate sharing contract. -- "Rebate sharing contract" means a contract between a pharmacy benefits manager and a purchaser under which the pharmacy benefits manager agrees to share manufacturer payments with the purchaser.

(q) Therapeutic interchange. --

   (1) "Therapeutic interchange" means any change from one prescription drug to another.

   (2) "Therapeutic interchange" does not include:

      (i) a change initiated pursuant to a drug utilization review;

      (ii) a change initiated for patient safety reasons;

      (iii) a change required due to market unavailability of the currently prescribed drug;

      (iv) a change from a brand name drug to a generic drug in accordance with § 12-504 of the Health Occupations Article; or

      (v) a change required for coverage reasons because the originally prescribed drug is not covered by the beneficiary's formulary or plan.

(r) Therapeutic interchange solicitation. -- "Therapeutic interchange solicitation" means any communication by a pharmacy benefits manager for the purpose of requesting a therapeutic interchange.

(s) Trade secret. -- "Trade secret" has the meaning stated in § 11-1201 of the Commercial Law Article.

HISTORY: 2008, ch. 36, § 6; chs. 201-206, 262, 279; 2011, ch. 65, § 5.