An Act Regarding Insurance Copayments for Short-term Prescriptions
Maine Legislature, Session 124, LD 0191
Committee: Insurance and Financial Services
Sponsors: PERRY, BRANNIGAN, JONES, TREAT, WEBSTER
Amends: 24-A MRSA §2765, 24-A MRSA §2847-Q, 24-A MRSA §4257

FIRST RRGULAR SESSION-2009 
Legislative Document 
No. 191 
H.P.156 
House of Representatives, January 21, 
An Act Regarding Insurance Copayments for Short-term 
Prescriptions 
Reference to the Committee on Insurance and Financial Services suggested and ordered 
printed. 
Presented by Representative PERRY of Calais. 
Cosponsored by Senator BRANNIGAN of Cumberland and 
~771de~ frJ· 71ltU~{ 
MILLICENT M. MacFARLAND 
Clerk 
Representatives: JONES of Mount Vernon, TREAT of Hallowell, WEBSTER of Freeport. 
Prinl~d Ull rccyclt.:d pupt:r 
Be it enacted by the People of the State of Maine as follows: 
Sec. 1. 24-A MRSA §2765 is enacted to read: 
) 
§2765. Copayments for short-term prescriptions 
An insurer that issues individual health insurance policies and contracts that provide 
coverage for prescription drugs shall adjust the copayment of an insured person to 
accommodate a short-term prescription for 14 days or less when short-term prescribing 
for that person is determined to be appropriate by the licensed health care professional 
who writes the prescription. The copayment must be proportional to the copayment for a 
longer time period. The requirements of this section apply to the insurer and to a 3rd-
party administrator or phannaceutical benefits manager under contract with the insurer. 
II 
The superintendent shall adopt rules to implement this section. The rules must include a 
penalty provision applicable to an insurer that fails to provide coverage as required by 
this section and the rules adopted pursuant to this section. The penalty provision must 
require an insurer that does not comply with the requirements of this section and the rules 
adopted pursuant to this section to pay a contribution to the Unused Pharmaceutical 
Disposal Program Fund established under Title 22, section 2700, subsection 5. Rules 
adopted under this section are routine technical rules as defined by Title 5, chapter 375, 
subchapter 2-A. As pm1 of the rule-making process, notice must be given to the joint 
standing committee of the Legislature having jurisdiction over insurance and financial 
services matters and the joint standing committee of the Legislature having jurisdiction 
over health and human services matters. 
Sec. 2. 24-A MRSA §2847-Q is enacted to read: 
) 
§2847-Q. Copayments for short-term prescriptions 
An insurer that issues group health insurance policies and contracts that provide 
coverage for prescription drugs shall adjust the copayment of an insured person to 
accommodate a sh0l1-term prescription for 14 days or less when short-term prescribing 
for that person is determined to be appropriate by the licensed health care professional 
who writes the prescription. The copayment must be proportional to the copayment for a 
longer time period. The requirements of this section apply to the insurer and to a 3rd-
party administrator or phannaceutical benefits manager under contract with the insurer. 
. 
The superintendent shall adopt rules to implement this section. The rules must include a 
penalty provision applicable to an insurer that fails to provide coverage as required by 
this section and the rules adopted pursuant to this section. The penalty provision must 
require an insurer that does not comply with the requirements of this section and the rules 
adopted pursuant to this section to pay a contribution to the Unused Pharmaceutical 
Disposal Program Fund established ullder Title 22, section 2700, subsection 5. Rules 
adopted under this section are routine technical rules as defined by Title 5, chapter 375, 
subchapter 2-A. As part of the rule-making process, notice must be given to the joint 
standing committee of the Legislature having jurisdiction over insurance and financial 
services matters and the joint standing committee of the Legislature having jurisdiction 
over health and human services matters. 
') 
n 
( 
/ 
'~---" 
L! 
Sec. 3. 24-A MRSA §4257 is enacted to read: 
§4257. Copayments for short-term prescriptions 
A health maintenance organization that issues individual and group health care 
contracts that provide coverage for prescription drugs shall adjust the copayment of an 
insured person to accommodate a shOIt-term prescription for 14 days or less when short-
term prescribing for that person is determined to be appropriate by the licensed health 
care professional who writes the prescription. The copayment Illust be propoltional to the 
copayment for a longer time period. The requirements of this section apply to the health 
maintenance organization and to a 3rd-paliy administrator or pharmaceutical benefits 
manager under contract with the insurer. 
The superintendent shall adopt rules to 
II 
implement this section. The rules must include a penalty provision applicable to a health 
maintenance organization that fails to provide coverage as required by this section and 
the rules adopted pursuant to this section. The penalty provision must require a health 
maintenance organization that docs not comply with the requirements of this section and 
the rules adopted pursuant to this section to pay a contribution to the Unused 
Pharmaceutical Disposal Program Fund established under Title 22, section 2700, 
subsection 5. Rules adopted under this section are routine technical rules as defined by 
Title 5, chapter 375, subchapter 2-A. As palt of the rule-making process, notice must be 
given to the joint standing committee of the Legislature having jurisdiction over 
insurance and financial services matters and the joint standing committee of the 
Legislature having jurisdiction over health and human services matters. 
Sec. 4. Application. The requirements of this Act apply to all policies, contracts 
and celtificates executed, delivered, issued for delivery, continued or renewed in this 
State on or after January 1,2010. For the purposes of this Act, all contracts are deemed 
to be renewed no later than the next yearly anniversary of the contract date. 
SUMMARY 
This bill requires an individual or group health insurer, a health maintenance 
organization that provides health coverage for prescription drugs and a 3rd-paliy 
administrator or pharmaceutical benefits manager to adjust the copayment to 
accommodate a short-term prescription. The copayment must be proportional. The bill 
requires the Superintendent of Insurance to adopt routine technical rules that include a 
penalty provision. The penalty provision must require an insurer that does not comply 
with the requirements and rules to pay a contribution to the Unused Pharmaceutical 
Disposal Program Fund established under the Maine Revised Statutes, Title 22, section 
2700, subsection 5. As part of the rule-making process, notice must be given to the joint 
standing committee of the Legislature having jurisdiction over insurance and financial 
services matters and the joint standing committee of the Legislature having jurisdiction 
over health and human services matters. The requirements apply to policies, contracts 
and celtificates executed, delivered, issued for delivery, continued or renewed in this 
State on or after January I, 20 I O.