An Act To Protect Consumers from Unfair Practices Related to Pharmacy Benefits Management
Maine Legislature, Session 129, LD 1504
Committee Amendment CA_A_S253 (Senate)

COMMITTEE AMENDMENT "ft" to S.P. 466, L.D. 1504, Bill, "An Act To 
Protect Consumers from Unfair Practices Related to Pharmacy Benefits Management" 
Amend the bill in section 8 in §4347 by striking out all of subsection 3 (page 2, lines 
to 6 in L.D.) and inserting the following: 
'3. Carrier. "Carrier" has the same meaning as in section 4301-A, subsection 3, 
except that "carrier" does not include a multiple-employer welfare arrangement, as 
defmed in section 6601, subsection 5, if the multiple-employer welfare arrangement 
contracts with a 3rd-party administrator to manage and administer health benefits, 
including benefits for prescription drugs. "Carrier" also includes the MaineCare program 
pursuant to Title 22, chapter 855 and the group health plan provided to state employees 
and other eligible persons pursuant to Title 5, section 285.' 
Amend the bill in section 8 in §4349 in subsection 4 in paragraph A in the first line 
(page 5, line 18 in L.D.) by striking out the following: 
11copayment
and inserting the 
following: 'cost-sharing amount' 
Amend the bill in section 8 in §4349 in subsection 4 by striking out all of paragraph 
C (page 5, lines 22 and 23 in L.D.) and inserting the following: 
'C. The total amount the pharmacy will be reimbursed for the prescription drug from 
the pharmacy benefits manager or carrier, including the cost-sharing amount paid by 
a covered person.' 
Amend the bill in section 8 in §4350-A by striking out all of subsection 1 (page 7, 
lines 30 to 34 in L.D.) and inserting the following: 
'1. Compensation used to reduce point-of-sale costs, improve benefits or lower 
premiums. All compensation remitted by or on behalf of a pharmaceutical manufacturer, 
developer or labeler, directly or indirectly, to a carrier, or to a pharmacy benefits manager 
under contract with a carrier, related to its prescription drug benefits must be: 
A. Remitted directly to the covered person at the point of sale to reduce the out-of-
pocket cost to the covered person associated with a particular prescription drug; or 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT" R "to S.P. 466, L.D. 1504 { S ·"2.,s:::5) 
B. Remitted to. and retained by, the carrier. Compensation remitted to the carrier 
must be applied by the carrier in its plan design and in future plan years to offset the 
premium for covered persons.' 
Amend the bill in section 8 in §4350-B in subsection 2 in the 3rd line (page 8, line 5 
in L.D.) by inserting after the following: "of interest" the following: ', as described in 
paragraph A or B,' 
Amend the bill in section 8 in §4350-B by striking out all of subsection 4 (page 8, 
lines 16 to 28 in L.D.). 
Amend the bill in section 8 in §4350-D by inserting after subsection 4 the following: 
'5. 
Documentation from pharmacy benefits manager. 
A pharmacy benefits 
manager shall provide any necessary documentation requested by a carrier that relates to 
pharmacy benefits manager compensation in order to comply with the requirements of 
this section.' 
Amend the bill by relettering or renumbering any nonconsecutive Part letter or 
section number to read consecutively. 
SUMMARY 
This amendment makes the following changes to the bill. 
1. It clarifies the provision related to excess payments at the point of sale. 
2. It requires that all compensation remitted by or on behalf of a pharmaceutical 
manufacturer, developer or labeler, directly or indirectly, to a carrier or to a pharmacy 
benefits manager related to its prescription drug benefit must be remitted directly to the 
covered person at the point of sale or to the carrier to offset premiums for covered 
persons. 
3. It removes the provision related to prescription drug formularies used by carriers 
as it is duplicative of other provisions in current law. 
4. It clarifies that the definition of "carrier" does not include a multiple-employer 
welfare arrangement if the multiple-employer welfare arrangement contracts with a 3rd-
party administrator to manage and administer health benefits, including benefits for 
prescription drugs. 
FISCAL NOTE REQUJRED 
(See Attached) 
COMMITTEE AMENDMENT 
Approved: 05/29/19 :tW.aC!-
LD 1504 
LR382(02) 
An Act To Protect Consumers from Unfair Practices Related to Pharmacy Benefits Management 
Fiscal Note for Bill as Amended by Committee Amendment '1{' Cs-zs3) 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Minor revenue increase - General Fund 
Minor revenue increase - Other Special Revenue Funds 
Correctional and Judicial Impact Statements 
The additional workload associated with the minimal number of new cases filed in the court system does not require 
additional funding at this time. 
The collection of additional fine revenue will increase General Fund and dedicated revenue by minor amounts. 
Fiscal Detail and Notes 
Any additional costs to the Department of Health and Human Services from the provisions of this bill are expected to 
be minor and can be absorbed within existing budgeted resources. 
LR0382(02) - Fiscal Note - Page 1 of 1