PROPOSAL
Maryland Register
Issue Date: July 20, 2018
Volume 45 • Issue 15 • Page 735 - 736
Title 10
MARYLAND DEPARTMENT OF HEALTH
Subtitle 09 MEDICAL CARE PROGRAMS
10.09.03 Pharmacy Services
Authority: Health-General Article, §§2-104(b), 15-103, 15-103.1, 15-105, [and] 15-118, and 15-148, Annotated Code of Maryland
Notice of Proposed Action
[18-181-P]
The Secretary of Health proposes to amend Regulation .05 under COMAR 10.09.03 Pharmacy Services.
Statement of Purpose
The purpose of this action is to:
(1) Increase, from a 6–month supply to a 12–month supply, the amount of contraceptive prescriptions that may be supplied to an enrollee at one time under the Maryland Medical Assistance Program (Medicaid), in accordance with S.B. 774/H.B. 994 (Chs. 464 and 465, Acts of 2018); and
(2) Clarify that Medicaid does not cover a drug or product that the Department of Health determines is not medically necessary and for which coverage is not otherwise required by regulation.
Comparison to Federal Standards
There is no corresponding federal standard to this proposed action.
Estimate of Economic Impact
I. Summary of Economic Impact. The requirement for Medicaid coverage expansion from 6 months to 12 months for contraceptive prescriptions will increase expenditures by the Department.
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Revenue (R+/R-) |
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II. Types of Economic Impact. |
Expenditure
(E+/E-) |
Magnitude |
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A. On issuing agency: |
(E+) |
$1,822,350 |
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B. On other State agencies: |
NONE |
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C. On local governments: |
NONE |
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Benefit (+)
Cost (-) |
Magnitude |
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D. On regulated industries or trade groups: |
NONE |
$1,822,350 |
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E. On other industries or trade groups: |
NONE |
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F. Direct and indirect effects on public: |
NONE |
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III. Assumptions. (Identified by Impact Letter and Number from Section II.) |
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A. The impact on the Department is based on an estimate of expenditure required to cover months 7—12 of a contraceptive prescription. New expenditures are expected to total $1,822,350, with $182,235 from the State General Fund and $1,640,115 in federal funds. |
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D. The regulated industry (i.e., businesses that dispense prescription contraceptives) will see a boost in revenue equal to $1,822,350 due to the additional 6 months of contraceptives individuals may seek. |
Economic Impact on Small Businesses
The proposed action has minimal or no economic impact on small businesses.
Impact on Individuals with Disabilities
The proposed action has no impact on individuals with disabilities.
Opportunity for Public Comment
Comments may be sent to Michele Phinney, Director, Office of Regulation and Policy Coordination, Maryland Department of Health, 201 W. Preston Street, Room 512, Baltimore, MD 21201, or call 410-767-6499 (TTY 800-735-2258), or email to [email protected], or fax to 410-767-6483. Comments will be accepted through August 20, 2018. A public hearing has not been scheduled.
.05 Limitations.
A. Except as specifically identified as being covered under Regulation .04 of this chapter, the following are not covered:
(1)—(17) (text unchanged)
(18) Drugs or products used for hair growth or other cosmetic purposes; [and]
(19) Any drug or supply that is covered and reimbursed by the Department under any other chapter of this subtitle; and
(20) Any drug or product the Department determines is not medically necessary.
B. (text unchanged)
C. Limitations on Covered Services.
(1)—(2) (text unchanged)
(3) Days Supply.
(a)—(b) (text unchanged)
(c) [Maintenance] Unless otherwise specified, maintenance medication shall be limited to:
(i)—(ii) (text unchanged)
(d)—(g) (text unchanged)
(h) [Birth control pills] Whether for an initial or subsequent prescription, contraceptive prescriptions may be dispensed in up to a [6] 12 months supply at one time.
(4)—(9) (text unchanged)
D.—E. (text unchanged)
ROBERT R. NEALL
Secretary of Health
