LAW WITHOUT
GOVERNOR'S CHAPTER
SIGNATURE
744
MAY 7, 2022 PUBLIC LAW
STATE OF MAINE
_____
IN THE YEAR OF OUR LORD
TWO THOUSAND TWENTY-TWO
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S.P. 621 - L.D. 1783
An Act To Require Health Insurance Carriers and Pharmacy Benefits
Managers To Appropriately Account for Cost-sharing Amounts Paid on
Behalf of Insureds
Be it enacted by the People of the State of Maine as follows:
Sec. 1. 24-A MRSA §4349, sub-§6 is enacted to read:
6. Cost-sharing amounts paid on behalf of covered person. The requirements of
this subsection apply to the calculation of a covered person's contribution to any applicable
cost-sharing or other out-of-pocket expense under a covered prescription drug benefit.
A. When calculating a covered person's contribution to any applicable cost-sharing or
other out-of-pocket expense under a covered prescription drug benefit, a carrier or
pharmacy benefits manager shall give credit for any waiver or discount of, or payment
made by a 3rd party for, the amount of, or any portion of the amount of, the applicable
cost-sharing or other out-of-pocket expense for the covered prescription drug that is
either:
(1) Without a generic equivalent; or
(2) With a generic equivalent when the covered person has obtained access to the
covered prescription drug through prior authorization, a step therapy override
exception or other exception or appeal process.
B. A 3rd party that pays as financial assistance any amount, or portion of the amount,
of any applicable cost-sharing or other out-of-pocket expense on behalf of a covered
person for a covered prescription drug:
(1) Shall notify the covered person prior to or within 7 days of the acceptance of
the financial assistance of the total amount of assistance available and the duration
for which it is available; and
(2) May not condition the assistance on enrollment in a specific health plan or type
of health plan, except as permitted under federal law.
C. If under federal law, with respect to a high-deductible health plan offered for use
with a health savings account in accordance with the federal Internal Revenue Code,
Page 1 - 130LR2363(03)
 the application of paragraph A would result in ineligibility for a health savings account,
this subsection applies only with respect to the deductible of such a plan after the
covered person has satisfied the minimum deductible under the federal Internal
Revenue Code, Section 223, except for items or services that are determined to be
preventive care pursuant to the federal Internal Revenue Code, Section 223(c)(2)(C),
in which case the requirements of paragraph A apply regardless of whether the
minimum deductible under the federal Internal Revenue Code, Section 223 has been
satisfied.
Sec. 2. Application. The requirements of this Act apply to prescription drug benefits
provided pursuant to a contract or policy of insurance by a carrier or a pharmacy benefits
manager on behalf of a carrier on or after January 1, 2023.
Page 2 - 130LR2363(03)