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<regulation prefix="Regulation" num=".04" citation="COMAR 14.01.04.04" title_num="14" subtitle_num="01" chapter_num="04" heading="Request for Information for Cost Review.">
  <paragraph num="A.">
    <text>Request for Information.</text>
    <paragraph num="(1)">
      <text>The Board shall post notice of the prescription drug product or products selected for cost review through the process outlined in Regulation .03I of this chapter on the Board’s website.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>To the extent there is no publicly available information to conduct an aspect of the statutory cost review, the Board may request information to conduct a cost review study under Health-General Article, §21-2C-09(a)(2), Annotated Code of Maryland, and this regulation.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Board may request information by sending an email or postal mail to the manufacturer, PBMs, health insurance carriers, wholesale distributors, HMOs, and MCOs.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The Board shall post notice of the request for information on its website.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>An entity that has not received a request for information from the Board may submit relevant information in accordance with this regulation.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Within 30 days of the date the request for information is posted to the website or transmitted to the entity, an entity may submit the information requested by the Board, and any other relevant information, in accordance with §C of this regulation.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>An entity may request one 30-day extension of time to submit information under §A(6) of this regulation.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>An entity shall submit the request for a 30-day extension to the Board in writing on or before the expiration of the initial submission period.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>For each prescription drug product under review, the Board may request the following information from:</text>
    <paragraph num="(1)">
      <text>Manufacturer:</text>
      <paragraph num="(a)">
        <text>Documents and research explaining the relationship between the pricing of the prescription drug product and the cost of development, the relationship between the pricing of the prescription drug product and the therapeutic benefit, and information that is otherwise pertinent to the manufacturer’s pricing decision such as:</text>
        <paragraph num="(i)">
          <text>Life cycle management;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Net average price in the State; and</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>The estimated value or cost-effectiveness of the prescription drug product;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>The total amount of the price concessions, discounts, and rebates provided to each payor type operating in the State;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The total amount of the price concessions, discounts, and rebates the manufacturer is expected to provide to each payor type;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The net price received by manufacturers for the drug product in the State accounting for all price concessions, discounts, and rebates;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The units of the prescription drug product sold in the State;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>The units of the prescription drug product sold nationally;</text>
      </paragraph>
      <paragraph num="(g)">
        <text>The total dollar amount of sales of the prescription drug product into the State;</text>
      </paragraph>
      <paragraph num="(h)">
        <text>The total dollar amount of sales of the prescription drug product nationally;</text>
      </paragraph>
      <paragraph num="(i)">
        <text>The invoice price per unit for the prescription drug product charged to purchasers in the United Kingdom, Germany, France, and Canada, reported in U.S. dollars;</text>
      </paragraph>
      <paragraph num="(j)">
        <text>Prices charged to purchasers in the State, including but not limited to pharmacies, pharmacy chains, pharmacy wholesalers, and other direct purchasers;</text>
      </paragraph>
      <paragraph num="(k)">
        <text>The average profit margin of the prescription drug product over the prior 5-year period and the projected profit margin anticipated for the current year for the prescription drug product;</text>
      </paragraph>
      <paragraph num="(l)">
        <text>Maryland and national gross and net manufacturer revenues for the prescription drug product under review for the most recent tax year;</text>
      </paragraph>
      <paragraph num="(m)">
        <text>Information concerning all authorized generics as defined by 42 CFR §447.502 for the prescription drug product;</text>
      </paragraph>
      <paragraph num="(n)">
        <text>Information concerning all other ANDAs, BLAs, and NDAs that pertain to the same active moiety and the same manufacturer;</text>
      </paragraph>
      <paragraph num="(o)">
        <text>The manufacturer’s research and development costs, as indicated on the manufacturer’s federal tax filing or information filed with the Federal Securities and Exchange Commission for the most recent tax year;</text>
      </paragraph>
      <paragraph num="(p)">
        <text>The portion of direct-to-consumer marketing costs eligible for favorable federal tax treatment in the most recent tax year that are specific to the prescription drug product under review; and</text>
      </paragraph>
      <paragraph num="(q)">
        <text>Any additional factors or information the manufacturer proposes that the Board consider.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Health Insurance Carrier, HMO, and MCO:</text>
      <paragraph num="(a)">
        <text>The total amount of the price concessions, discounts, and rebates the manufacturer provides to each health plan operating in the State, expressed as a percent of the WAC;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The average price concession, discount, and rebate provided in the State for therapeutic alternatives;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Placement in each formulary offered or administered in the State and the number of covered lives for each formulary;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Benefit design around the prescription drug product, including copayment and coinsurance amounts in the State;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>The net cost incurred by the insurance carrier for the prescription drug product in the State; and</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Any additional factors or information the health insurance carrier, HMO, or MCO proposes that the Board consider.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>Pharmacy Benefits Managers:</text>
      <paragraph num="(a)">
        <text>The therapeutic alternatives for the prescription drug product(s) under review identified by each formulary administered by the PBM;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The total amount of the price concessions, discounts, and rebates the manufacturer provides to each PBM operating in the State, expressed as a percent of the WAC;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The average price concession, discount, and rebate provided in the State for therapeutic alternatives;</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Placement in each formulary offered or administered in the State and the number of covered lives for each formulary;</text>
      </paragraph>
      <paragraph num="(e)">
        <text>Benefit design around the prescription drug product, including copayment and coinsurance amounts;</text>
      </paragraph>
      <paragraph num="(f)">
        <text>Maryland and national gross and net PBM revenues for the prescription drug product under review for the most recent tax year; and</text>
      </paragraph>
      <paragraph num="(g)">
        <text>Any additional factors or information the PBM proposes that the Board consider.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>Wholesale Distributors:</text>
      <paragraph num="(a)">
        <text>Prices charged to purchasers in the State, including but not limited to pharmacies, pharmacy chains, pharmacy wholesalers, and other direct purchasers;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The total amount of price concessions and discounts provided by the wholesale distributor to purchasers in the State, including but not limited to pharmacies, pharmacy chains, pharmacy wholesalers, and other direct purchasers;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Units of the prescription drug product sold in the State; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>Any additional factors or information the wholesale distributor proposes that the Board consider.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Submission of Information.</text>
    <paragraph num="(1)">
      <text>An entity may submit the information requested in §A of this regulation by:</text>
      <paragraph num="(a)">
        <text>Completing the data form developed by the Board; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Providing supporting documentation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>A person submitting information, including data and records, for the Board’s consideration shall comply with the procedures for designating confidential, trade-secret, and proprietary information set forth in COMAR 14.01.01.04.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Information may be submitted to the Board:</text>
      <paragraph num="(a)">
        <text>In paper form using a tracked common carrier, courier, or postal service; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Electronically using secure file transfer.</text>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>