Maryland 340B Program Legislation

Welcome to RxParadigm’s series on 340B Program State-Level Legislation. State-level initiatives to manage the 340B Program vary greatly across the country, and over 30 states have introduced or passed legislation to protect the 340B program. In this series over the next few weeks, we will define and analyze various states’ policies around contract pharmacy protection laws, Managed Medicaid pharmacy benefits carve out, modifier rules for Medicaid and commercial claims, 340B claims identification and PBM reimbursement protection law. In this article, we examine Maryland’s 340B program legislation.??

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Contract Pharmacy Protection and PBM Reimbursement Protection?

?Effective in 2022, Maryland’s state law prohibits PBMs from discriminating against 340B covered entities and reimbursing 340B entities at a lower rate that non-340B entities. However, the law does not prohibit PBMS from the discriminatory practice of requiring modifiers to identify 340B Drugs.??

A separate law effective Spring 2024 prohibits drug manufacturers from restricting 340B entities use of contract pharmacies to distribute 340B drugs.??

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Medicaid MCO?

?Maryland carves in Medicaid pharmacy benefits into their Medicaid Managed Care contracts. Most states use a general carve-in model, which allows the 340B discount benefits to be retained by CEs, rather than by the state.??

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Claim Modifier?

Maryland does not use claims modifiers to identify 340B claims. Claims modifiers are a common but often ineffective tool used to counter duplicate discounts. An IQVIA study found that only 50% of claims included a 340B modifier at entity-owned pharmacies. The study concluded that modifiers are not sufficient to identify 340B drugs, and better tools are needed to combat duplicate discounts.??

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Conclusion?

Maryland is a leading state in 340B protection legislation. By prohibiting contract pharmacy restrictions and PBM discrimination, using a carve-in MCO model, and forgoing 340B claims modifiers Maryland works to ensure that 340B benefits are distributed as intended by the program.?

However, State law does not prevent PBMS from using modifiers to discriminate against 340B entities, a gap where even greater 340B protection could be implemented. Thanks for reading, and make sure to check out the rest of our series.??

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