HB 170
Department of Legislative Services
Maryland General Assembly
2021 Session
FISCAL AND POLICY NOTE
First Reader
House Bill 170 (Delegate K. Young)
Health and Government Operations
Cancer Drugs – Physician Dispensing and Coverage
This bill authorizes a physician with a valid dispensing permit to personally dispense to a
patient or a patient of the physician’s practice, by mail or other commercial method (1) a
starter dosage of a cancer drug or device or (2) an initial or refill prescription of a cancer
drug. An insurer, nonprofit health service plan, or health maintenance organization
(collectively known as carriers) must allow an insured or enrollee to obtain a covered
specialty drug that is a “cancer drug” from a dispensing physician. A pharmacy benefits
manager (PBM) must allow a beneficiary to obtain a cancer drug from a dispensing
physician. The bill takes effect January 1, 2022, and applies to all policies, contracts,
and health benefit plans issued, delivered, or renewed in the State on or after that
date.
Fiscal Summary
State Effect: Minimal increase in special fund revenues for the Maryland Insurance
Administration in FY 2022 from the $125 rate and form filing fee. Contractual assistance
may be required to review forms in FY 2022 only. Any impact on Medicaid is
indeterminate, as discussed below. No meaningful impact on the State Employee and
Retiree Health and Welfare Benefits Program.
Local Effect: Any impact on prescription drug expenditures for local jurisdictions is
indeterminate, as discussed below. Revenues are not affected.
Small Business Effect: Meaningful.
Analysis
Current Law: Under the Maryland Pharmacy Act, a person must be licensed by the State
Board of Pharmacy in order to practice pharmacy in the State, which includes the
dispensing of prescription drugs. “Dispensing” means the procedure that results in the
receipt of a prescription or nonprescription drug or device by a patient or the patient’s agent
and that entails (1) the interpretation of an authorized prescriber’s prescription for a drug
or device; (2) the selection and labeling of the drug or device prescribed pursuant to that
prescription; and (3) measuring and packaging of the prescribed drug or device in
accordance with State and federal laws.
This requirement does not prohibit specified individuals from personally preparing and
dispensing prescriptions under specified circumstances, including a licensed physician who
(1) has applied to the State Board of Physicians (MBP); (2) demonstrated to the satisfaction
of MBP that the dispensing of prescription drugs or devices by the physician is in the public
interest; (3) has received a written permit from MBP to dispense prescription drugs or
devices, with the exception of starter dosages or samples without charge; and (4) posts a
sign conspicuously positioned and readable regarding the process for resolving incorrectly
filled prescriptions or includes written information regarding the process with each
prescription dispensed. The physician also must:
comply with dispensing and labeling requirements;
record the dispensing of the prescription drug or device on the patient’s chart;
allow the Office of Controlled Substances Administration to enter and inspect the
physician’s office at all reasonable hours;
provide the patient with a written prescription and maintain prescription files;
not direct patients to a single pharmacist or pharmacy;
not receive remuneration for referring patients to a pharmacist or pharmacy;
comply with the child resistant packaging requirements;
comply with drug recalls;
maintain biennial inventories and comply with any other federal and State
recordkeeping requirements relating to controlled dangerous substances;
purchase prescription drugs from a pharmacy or wholesale distributor who holds a
permit issued by the State Board of Pharmacy;
report annually to MBP whether the physician has personally prepared and
dispensed prescription drugs within the previous year; and
complete 10 hours of continuing medical education over a five-year period relating
to the preparing and dispensing of prescription drugs.
HB 170/ Page 2
Generally, a carrier may require a covered specialty drug to be obtained through a
designated pharmacy or other authorized source or a pharmacy participating in the carrier’s
network, if the carrier determines that pharmacy meets the carrier’s performance standards
and accepts the carrier’s network reimbursement.
“Specialty drug” means a prescription drug that (1) is prescribed for an individual with a
complex, chronic, or rare medical condition; (2) costs $600 or more for up to a 30-day
supply; (3) is not typically stocked at retail pharmacies; and (4) requires a difficult or
unusual process of delivery to the patient in the preparation, handling, storage, inventory,
or distribution of the drug or requires enhanced patient education, management, or support,
beyond those required for traditional dispensing before or after administration of the drug.
State Fiscal Effect: Although the bill does not specifically apply to Medicaid, it requires
a PBM to allow a beneficiary to obtain a cancer drug from a dispensing physician. All
nine Medicaid managed care organizations use PBMs. As the bill does not specify
reimbursement for dispensing physicians, there is insufficient information to determine
whether Medicaid prescription drug expenditures increase, decrease, or remain the same.
To the extent expenditures increase or decrease, federal matching fund revenues are
impacted correspondingly.
Local Expenditures: As noted above, the bill does not specify reimbursement for
dispensing physicians. Thus, any impact on prescription drug costs for local governments
that purchase fully insured plans and/or utilize PBMs is indeterminate.
Small Business Effect: Physicians with a valid dispensing permit may dispense cancer
drugs to patients as specified.
Additional Information
Prior Introductions: None.
Designated Cross File: None.
Information Source(s): Department of Budget and Management; Maryland Department
of Health; Maryland Health Benefit Exchange; Maryland Insurance Administration;
Department of Legislative Services
Fiscal Note History: First Reader - January 18, 2021
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HB 170/ Page 3
Analysis by: Jennifer B. Chasse Direct Inquiries to:
(410) 946-5510
(301) 970-5510
HB 170/ Page 4
Statutes affected: Text - First - Cancer Drugs – Physician Dispensing and Coverage: 12-102 Insurance, 15-847 Insurance, 15-1611.1 Insurance