(a) In this section, “authorized prescriber” has the meaning stated in § 12-101 of the Health Occupations Article.
Application of section
(b) This section applies to:
(1) insurers and nonprofit health service plans that provide coverage for contraceptive drugs and devices under individual, group, or blanket health insurance policies or contracts that are issued or delivered in the State; and
(2) health maintenance organizations that provide coverage for contraceptive drugs and devices under individual or group contracts that are issued or delivered in the State.
Prohibitions
(c)(1) This subsection does not apply to a health benefit plan that is a grandfathered health plan, as defined in § 1251 of the Affordable Care Act.
(2) An entity subject to this section:
(i) except for a drug or device for which the U.S. Food and Drug Administration has issued a black box warning, may not apply a prior authorization requirement for a contraceptive drug or device that is:
1. A. an intrauterine device; or
B. an implantable rod;
2. approved by the U.S. Food and Drug Administration; and
3. obtained under a prescription written by an authorized prescriber; and
(ii) except as provided in paragraph (3) of this subsection, may not apply a copayment or coinsurance requirement for a contraceptive drug or device that is:
1. approved by the U.S. Food and Drug Administration; and
2. obtained under a prescription written by an authorized prescriber.
(3) An entity subject to this section may apply a copayment or coinsurance requirement for a contraceptive drug or device that, according to the U.S. Food and Drug Administration, is therapeutically equivalent to another contraceptive drug or device that is available under the same policy or contract without a copayment or coinsurance requirement.
Coverage for a single dispensing of prescription contraceptives for 6-month period
(d)(1) An entity subject to this section shall provide coverage for a single dispensing to an insured or an enrollee of a supply of prescription contraceptives for up to a 12-month period.
(2) Whenever an entity subject to this section increases the copayment for a single dispensing of a supply of prescription contraceptives for up to a 12-month period, the entity shall also increase proportionately the dispensing fee paid to the pharmacist.
(3) This subsection may not be construed to require a provider to prescribe, furnish, or dispense 12 months of contraceptives at one time.
Coverage without a prescription for contraceptive drugs available by prescription and over the counter
(e)(1) Subject to paragraph (2) of this subsection, an entity subject to this section:
(i) shall provide coverage without a prescription for all contraceptive drugs approved by the U.S. Food and Drug Administration and available by prescription and over the counter; and
(ii) may not apply a copayment or coinsurance requirement for a contraceptive drug dispensed without a prescription under item (i) of this paragraph that exceeds the copayment or coinsurance requirement for the contraceptive drug dispensed under a prescription.
(2) An entity subject to this section:
(i) may only be required to provide point-of-sale coverage under paragraph (1)(i) of this subsection at in-network pharmacies; and
(ii) may limit the frequency with which the coverage required under paragraph (1)(i) of this subsection is provided.
Credits
Added by Acts 2016, c. 436, § 1, eff. Jan. 1, 2018; Acts 2016, c. 437, § 1, eff. Jan. 1, 2018. Amended by Acts 2018, c. 450, § 1, eff. Jan. 1, 2020; Acts 2018, c. 510, § 1, eff. Oct. 1, 2018; Acts 2018, c. 511, § 1, eff. Oct. 1, 2018.
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
