An Act to Protect
Maine Legislature, Session 132, LD 1018
Committee Amendment CA_A_S402 (Senate)
Amends: 22 MRSA §1728

COMMITTEE AMENDMENT "A-•• to S.P. 435, L.D. 1018, "An Act to Protect 
Health Care for Rural and Underserved Areas by Prohibiting Discl'imination by 
Pa1ticipants in a Federal Drng Discount Progrnm
Amend the bill by striking out everything after the enacting clause and insetting the 
following: 
'Sec, 1. 22 MRSA §1728, sub-§1, as enacted by PL 2023, c. 276, § 1, is repealed. 
Sec. 2, 22 MRSA §1728, sub-§1-A is enacted to read: 
1-A. Definitions. As used in this section. unless the context otherwise indicates. the 
following terms have the following meanings. 
A. "Hospital" means: 
( l) An acute care institution licensed and operating in this State as a hospital under 
section 1811 or the parent of such an institution: or 
(2) A hospital subsidiary 01· hospital affiliate in the State that provides medical 
services or medically related diagnostic and laboratory services or engages in 
ancilla1y activities suppo1ting those se1·vices. 
B. 
11340B contmct pha1·macy
has the same meaning as in Title 24-A. section 7752, 
subsection 5. 
C. "340B drug" has the same meaning as in Title 24-A. section 7752. subsection 6. 
D. 
11340B entity" has the same meaning as in Title 24-A. section 7752. subsection 7. 
Sec, 3, 22 MRSA §1728, sub-§2-A is enacted to read: 
2~A. Additional reporting by hospitals on participation in federal 340B drug 
prog1·am. In addition to any repo1i required pursuant to subsection 2. beginning July L 
2026, each hospital patticipating in the 340B program shall provide an annual repo1t to the 
Maine Health Data Organization. The Maine Health Data Organization shall post the report 
on its publicly accessible website. Each hospital shall 1·eport in a standardized format. as 
COMMITTEE AMENDMENT 
ROS 
COMMITTEE AMENDMENT"k" to S.P. 435, L.D. 1018 ( s- 6/c>'J-J 
l 
agreed upon by the Maine Health Data Organization and the hospital. and include. at a 
minimum, the following information in the report: 
A. The hospital's national provider identification number; 
B. The name of the hospital; 
C. The address of the hospital for the purpose of accepting service of process: 
D. The classification of the hospital: 
E. The aggregated acquisition cost for the prescription drugs obtained under the 340B 
program: 
F. The aggregated payment amount received for the prescription drugs obtained under 
l O 
the 340B program and dispensed to patients; 
G. The number of pricing units dispensed or administered for prescription drugs 
described in paragraph F: 
H. The aggregated payments made: 
(1) To 340B contract pharmacies to dispense 340B drngs: 
(2) To any other entity that is not the 340B entity and is not a 340B contract 
pharmacy for managing any aspect of the hospital's 340B program; and 
(3) For all other expenses related to administering the 340B progt·am: and 
I. The number of claims for prescription drugs described in parngraph H. 
. The information required under this subsection must be 1·eported by payor type, including 
commercial insurance, medical assistance, the MaineCare program and Medicare as 
required by the Maine Health Data Organization. The information for paragraphs E to G 
must also be reported at the National Drug Code level for the SO most frequently dispensed 
prescription drngs by the hospital under the 340B progrnm. The information must include 
all physician-administered and physician-dispensed prescription drugs. 
Data submitted must also include prescription drngs dispensed by outpatient facilities that 
are identified as child facilities under the 340B program based on their inclusion on a 
hospital's Medicare cost report. 
Sec. 4. 22 MRSA §1728, sub-§3, as enacted by PL 2023, c. 276, § l, is amended to 
read: 
3. Repo1·ting. The Maine Health Data Organization shall produce and post on its 
publicly accessible website a repo1t that includes a summary of the aggregate information 
received from hospitals requil'ed to report u11de1· subsection 2 and subsection 2-A. The 
Maine Health Data Organization shall submit the repo1t required by this subsection to the 
Office of Affordable Health Care, as established in Title 5, section 3122, the Maine 
Prescription Drug Affordability Boat·d, as established in Title 5, section 12004-G, 
subsection 14-I, and the joint standing committee of the Legislature having jurisdiction 
over health data repo1ting and prescription drug matters. 
Sec. 5, 24-A MRSA c, 103 is enacted to read: 
CHAPTER 103 
COMMITTEE AMENDMENT 
ROS 
COMMITTEE AMENDMENT" Pr· to S,P, 435, L.D, IO 18 ( Sr L/ o)) 
PROTECT HEALTH CARE FOR RURAL AND UNDERSERVED 
COMMUNITIES ACT 
§7751. Shol't title 
This chapter may be known and cited as "the Prntect Health Care for Rural and 
Underse1-ved Communities Act." 
§7752, Definitions 
As used in this chaptet', unless the context otherwise indicates. the following terms 
have the following meanings. 
1. Health insumnce issuer, "Health insurance issue1·
has the same meaning as 
IO 
11carrie1·" as defined in section 4301-A, subsection 3, 
2. Manufacturer. "Manufacture1·
has the same meaning as in Title 32, section 
13702-A, subsection 19. 
3, Pharmacy, 
11Pha1·macy
has the same meaning as in Title 32, section 13702-A. 
subsection 24. 
4. Ph1U'macy benefits manager. 
11Pharmacy benefits manager" has the same meaning 
as in section 4347, subsection 17. 
5, 340B contract pharmacy, 
11340B contract pharmacy" means a pharmacy that has a 
contract with a 340B entity to receive and dispense 340B drugs to the 340B entity's patients 
on behalf of the 340B entity. For the purposes of this chapter, a record of a current 340B 
contract pharmacy relationship between the 340B entity and the 340B contract pharmacy 
that is on the 340B United States Department of Health and Human Services. Health 
Resources and Services Administrntion, Office of Phannacy Affairs ·340B Information 
System website. or such publicly accessible successor website maintained by the United 
States Department of Health and Human Services. is pl'ima facie evidence of such a 
contract. 
6. 340B drug. 
11340B drug" means a drug that is purchased or eligible for purchase 
unde1· Section 340B of the federal Public Health Service Act. 42 United States Code. 
Section 256b(a)(3). 
7, 340B entity. 
11340B entity" means an entity pa1ticipating or authorized to participate 
in the federal 340B drug discount program. as described in 42 United States Code. Section 
2566. including its pharmacy. 01· any pharmacy contracted with the participating entity to 
dispense drugs purchased through the federal 340B drug discount prngram. 
§7753. Prohibition of certain discl'iminatory actions by manufacturer or agent related 
to 340B entities 
1. Interference with acquisition or delivery of 340B drugs prohibited, A 
manufacturer or its agent may not deny. restrict. prohibit or otherwise interfere with. either 
directly 01· indirectly. the acquisition of a 340B dmg by. or delivery of a 340B drng to, a 
340B contract pharmacy on behalf of a 340B entity unless receipt of that 340B drug is 
prohibited by the United States Department of Health and Human Services. 
2, Submission of claims or utilization data prohibited, A manufacturer 01· its agent 
may not. either directly or indirectly, require a 340B entity to submit any claims or 
COMMITTEE AMENDMENT 
ROS 
COMMITTEE AMENDMENT"A--" to S.P. 435, L,D, 1018 ( $-l../◊J.) 
utilization data as a condition for allowing the acquisition of a 340B drug by. or delivery 
of a 340B drug to, a 340B entity unless the claims 01· utilization data sharing is required by 
the United States Department of Health and Human Services. 
3. Other intel'ference prohibited, A manufacturer may not otherwise interfere 
directly 01· indirectly with a 340B entity unless expressly authorized by the United States 
Department of Health and Human Services. 
§7754, Prohibition of cet·tain discriminatory actions with respect to reimbul'sement 
of 340B entities 
With respect to reimbursement of a 340B entity for 340B drugs, a health insurance 
issuer, pharmacy benefits manager or other 3rd-party payor or agent may not: 
1. Reimbursement at lower rate prohibited. Reimburse a 340B entity for 340B drngs 
at a rate lower than that paid for the same drug to entities that al'e not 340B entities or lower 
the reimbursement amount for a claim on the basis that the claim is for a 340B drug: 
2, Imposition of different terms and conditions prohibited. Impose any terms 01· 
conditions on any 340B entity that differ from such terms or conditions applied to entities 
that are not 340B entities or pharmacies that are not 340B contract pharmacies because it 
is a 340B entity including. without limitation: 
A. Fees. charges. clawbacks or other adiustments or assessments. For purposes of this 
paragraph. "other adjustment or assessment" includes, without limitation. placing any 
additional requirements, restrictions 01· burdens upon the 340B entity that result in 
administrative costs or fees to the 340B entity that are not placed upon entities that a1·e 
not 340B entities, including affiliate pharmacies of the health insurance issuer. 
pharmacy benefits manager or other 3rd-party payor: 
B. Dispensing fees that a1·e less than the dispensing fees for entities that are not 340B 
entities or pharmacies that are not 340B contract pharmacies: 
C. Restrictions or requirements l'egarding participation in standard or preferred 
pharmacy networks: 
D. Requirements relating to inventory management systems or to the frequency or 
scope of audits; 
E. Requirements that a claim for a drug dispensed by a pharmacy include any 
identification. billing modifier, attestation or other indication that a dl'llg is a 340B drug 
in order to be processed or submitted or reimbursed unless it is required by the United 
States Department of Health and Human Services, Centers for Medicare and Medicaid 
Services or the Department of Health and Human Services for the administration of the 
MaineCare program; or 
F. Any other restrictions. conditions, practices or policies that al'e not imposed on 
entities that are not 340B entities: 
3, Reversal, resubmission or clarification of claims prohibitecl. Require a 340B 
entity to 1·everse, resubmit or clarify a claim after the initial adjudication unless these 
actions are in the normal course of pharmacy business and are not related to 340B drug 
pricing; 
COMMITTEE AMENDMENT 
ROS 
COMMITTEE AMENDMENT"A "to S.P. 435, L.D. 1018 { $- l/o"J.,) 
I 
4, Discrimination against 340B entity that interferes with patient choice. 
Discriminate against a 340B entity in a manner that prevents or interferes with a patient's 
choice to receive 340B drugs from the 340B entity, including the administrntion of the 
drugs. F01· pmposes of this subsection, it is considered a discdminatoty practice that 
prevents or interferes with a patient's choice to receive drngs at a 3408 entity if a health 
insurance issuer, pharmacy benefits manager or other 3rd~party payor places any additional 
requirements, restrictions or burdens upon the 340B entity that differ from the terms and 
conditions applied to entities that are not 340B entities that result in administrative costs or 
fees to the 340B entity, including, but not limited to, requiring a claim for a drug dispensed 
by a phamrncy to include any identification, billing modifier, attestation or other indication 
that a drug is a 340B drug in order to be processed or resubmitted unless it is required by 
the United States Department of Health and Human Services, Centers for Medicare and 
Medicaid Services or the Depat1ment of Health and Human Services for the administration 
of the MaineCare program; 
5, Discrimination against 340B entity that interferes with patient choice of 
delivery method. Include any other provision in a contract between a health insurance 
issuer, pharmacy benefits manager or other 3rd-party payor and a 340B entity that differs 
from the terms and conditions applied to entities that are not 340B entities that 
discriminates against the 340B entity that participates in the 340B prngram or prevents or 
interferes with a patient's choice to receive a 340B drug from a 340B entity, whether by 
direct administration, in-person dispensing, direct delive1y1 mail or other form of shipment: 
6. Restrictions or additional charges prohibited. Place a restriction or additional 
charge on a patient who chooses to receive 340B drngs from a 340B entity if the restriction 
or additional charge differs from the terms and conditions applied when patients choose to 
receive drugs that are not 340B drngs from an entity that is not a 340B entity or from a 
pharmacy that is not a 340B contract pharmacy; 
7, Submission of data pertaining to ingredient costs or pricing of 340B drugs 
prohibited, Require or compel the submission of ingredient costs or pricing data pettaining 
to 340B drugs from a 340B entity to any health insurance issuer, pharmacy benefits 
manager or other 3rd-party payor; or 
8. Exclusion from pba1·macy network prohibited, Exclude any 340B entity from the 
health insurance issuer, pharmacy benefits manager or other 3rd-party payor network on 
the basis that the 340B entity dispenses 340B drugs or refuse to contract with a 340B entity 
for reasons other than. those that apply equally to entities that are not 340B entities. 
This section may not be construed to limit a health insurance issuer's ability to use 
certain preferred pharmacies 01· develop networks of preferred pharmacies as long as a 
health insurance issuer's decision is not based on an entity's status as a 340B entity. 
§7755, MaineCare progt·am not affected 
This chapter does not apply to the MaineCare prngram as a payor when the MaineCare 
pl'ogrnm provides reimbursement for covered outpatient dmgs as defined in 42 United 
States Code, Section 1396r-8(k)(2). 
§7756. Contracting under 340B program 
As permitted under federal law and regulation, a 340B entity shall, to the extent 
possible, contract with a 340B contract pharmacy that is located in this State. 
Pnge 5 • 132LR0874(02) 
COMMITTEE AMENDMENT 
ROS 
COMMITTEE AMENDMENT"/}" lo S.P. 435, L.D. 1018 ( s, t/Dd-) 
§7757. Enforcement 
1. Enforcement; violation. Notwithstanding section 12-A. a violation of this chapter 
is subject to enforcement under the Maine Unfair Trade Practices Act, including any of the 
remedies provided for in that Act. A violation is committed each time a prohibited act 
under this chapter occms. An investigation of a violation by a manufacturer may include a 
wholesaler or 3rd patty that may possess evidence supporting that investigation. 
2, Exemption from enforcement. The limited distribution of a drng reguh'ed under 21 
United States Code, Section 355-1 is not a violation of this chapter. 
§7758, Federal preemption; statutory constt·uction 
1. No less restrictive than federal law. This chapter may not be constmed or applied 
to be less restrictive than federal law for a person or entity regulated by this chapter, 
2. No conflict with federal law ancl regulation or other laws of this State. This 
chapter may not be construed or applied in any manner that conflicts with: 
A. Applicable federal law and related rngulations; or 
B. Other laws of this State if the law is compatible with applicable federal law.' 
Amend the bill by relettering 01· renumbering any nonconsecutive Part letter or section 
number to read consecutively. 
SUMMARY 
This amendment replaces the bill and prohibits discrimination by pharmaceutical 
manufacturers, health insurance caniers, pharmacy benefits managers and their agents 
against pharmacies and health care providers that participate in the federal prescription 
drug discount program, known as the 340B drug discount progl'am, solely on the basis of 
participation in the 340B drug discount program. The amendment clarifies that the 
language pl'Ohibiting discrimination does not extend to the use of prefened networks by 
health insurance carriers and pharmacy benefits managers. The amendment requires that 
pha1·macies and health care providers pa1ticipating in the program must contract, to the 
extent possible and as permitted under federal law and regulation, with pharmacies located 
in this State. The amendment provides that enforcement under the Maine Unfair Trnde 
Practices Act is the exclusive enforcement mechanism and does not authorize a private 
cause of action fat· enfo!'cement. These pl'Ovisions do not apply to the MaineCare progrnm 
and include language to clarify that the provisions may not be constrned or applied in a 
way that conflicts with federal law. 
The amendment also requires hospitals that pa1ticipate in the 340B drug discount 
program to annually repo1t additional information to the Maine Health Data Organization 
related to their participation in the prngram beginning July 1, 2026. 
FISCAL NOTE REQUIRED 
(See attached) 
COMMITTEE AMENDMENT 
Approved: 05/31/25 l-Rl-
LD 1018 
LR 874(02) 
An Act to Protect Health Care for Rural and Underservccl Areas by Prohibiting Discrimination by 
Participants in a Fedc1·al Drug Discount Program 
Fiscal Note for Bill as Amended by Committee Amendment ;1J' (S ,tjt}\_ 
Committee: Health Coverage, Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - General Fund 
Minor revenue increase - General Fund 
Correctional and Judicial Impact Statements 
This bill may increase the number of civil suits fl.led in the comt system. 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 filing fees will increase General Ftmd revenue by minor amounts. 
LR0874(02) - Fiscal Note - Page I of I