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<section article="ghg" article_name="Health - General" number="19-108.5" title_number="19" title_name="Health Care Facilities" subtitle_number="1" subtitle_name="Health Care Planning and Systems Regulation">
  <level label="a">
    <level label="1">
      <text>In this section the following words have the meanings indicated.</text>
    </level>
    <level label="2">
      <text>“Carrier” has the meaning stated in § 15–1301 of the Insurance Article.</text>
    </level>
    <level label="3">
      <text>“Health care provider” has the meaning stated in § 19–108.3 of this subtitle.</text>
    </level>
  </level>
  <level label="b">
    <level label="1">
      <text>On or before July 1, 2026, a carrier shall establish and maintain an online process that:</text>
      <level label="i">
        <text>Links directly to all e–prescribing systems and electronic health record systems that use the National Council for Prescription Drug Programs SCRIPT standard and the National Council for Prescription Drug Programs Real Time Benefit Standard;</text>
      </level>
      <level label="ii">
        <text>Can accept electronic prior authorization requests from a health care provider;</text>
      </level>
      <level label="iii">
        <text>Can approve electronic prior authorization requests:</text>
        <level label="1">
          <text>For which no additional information is needed by the carrier to process the prior authorization request;</text>
        </level>
        <level label="2">
          <text>For which no clinical review is required; and</text>
        </level>
        <level label="3">
          <text>That meet the carrier’s criteria for approval; and</text>
        </level>
      </level>
      <level label="iv">
        <text>Links directly to real–time patient out–of–pocket costs, including copayment, deductible, and coinsurance costs, and more affordable medication alternatives made available by the carrier.</text>
      </level>
    </level>
    <level label="2">
      <text>A carrier may not:</text>
      <level label="i">
        <text>Impose a fee or charge on a person for accessing the online process required under paragraph (1) of this subsection; or</text>
      </level>
      <level label="ii">
        <text>Access, without health care provider consent, health care provider data via the online process other than for the insured or enrollee.</text>
      </level>
    </level>
  </level>
  <level label="c">
    <text>On or before July 1, 2025, a carrier shall:</text>
    <level label="1">
      <text>On request of a health care provider, provide contact information for each third–party vendor or other entity that the carrier will use to meet the requirements of subsection (b) of this section; and</text>
    </level>
    <level label="2">
      <text>Post the contact information required to be provided under item (1) of this subsection on its website.</text>
    </level>
  </level>
  <level label="d">
    <level label="1">
      <text>On or before July 1, 2026, each health care provider shall ensure that each e–prescribing system or electronic health record system owned or contracted for by the health care provider to maintain a health record of an insured or enrollee has the ability to access, at the point of prescribing:</text>
      <level label="i">
        <text>The electronic prior authorization process established by a carrier under subsection (b) of this section; and</text>
      </level>
      <level label="ii">
        <text>The real–time patient out–of–pocket cost information and available medication alternatives required under subsection (b) of this section.</text>
      </level>
    </level>
    <level label="2">
      <text>The Commission shall establish by regulation a process through which a health care provider may request and receive a waiver of compliance from the requirements of this subsection.</text>
    </level>
  </level>
  <level label="e">
    <level label="1">
      <text>On or before July 1, 2026, each carrier, or a pharmacy benefits manager on behalf of the carrier, shall:</text>
      <level label="i">
        <text>Provide real–time patient–specific benefit information to insureds and enrollees and contracted health care providers, including any out–of–pocket costs and more affordable medication alternatives or prior authorization requirements; and</text>
      </level>
      <level label="ii">
        <text>Ensure that the information provided under item (i) of this paragraph is accurate.</text>
      </level>
    </level>
    <level label="2">
      <text>Each carrier, or a pharmacy benefits manager on behalf of the carrier, shall make available the information required to be provided under paragraph (1) of this subsection to the health care provider at the point of prescribing in an accessible and understandable format, such as through the health care provider’s e–prescribing system or electronic health record system that the carrier, pharmacy benefits manager, or designated subcontractor has adopted that uses the National Council for Prescription Drug Programs SCRIPT standard and the National Council for Prescription Drug Programs Real Time Benefit Standard from which the health care provider makes the request.</text>
    </level>
  </level>
</section>
