LD 554
pg. 3
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LR 1315
Item 1

 
2. Required practices.__A pharmacy benefits manager owes a
fiduciary duty to a covered entity and shall discharge that duty
in accordance with the provisions of state and federal law.

 
A.__A pharmacy benefits manager shall perform its duties
with care, skill, prudence and diligence and in accordance
with the standards of conduct applicable to a fiduciary in
an enterprise of a like character and with like aims.

 
B.__A pharmacy benefits manager shall discharge its duties
with respect to the covered entity for the primary purpose
of providing benefits to covered individuals and defraying
reasonable expenses of administering health plans.

 
C.__A pharmacy benefits manager shall notify the covered
entity in writing of any activity, policy or practice of the
pharmacy benefits manager that directly or indirectly
presents any conflict of interest with the duties imposed by
this subsection.

 
D.__A pharmacy benefits manager shall provide to a covered
entity all financial and utilization information requested
by the covered entity relating to the provision of benefits
to covered individuals through that covered entity and all
financial and utilization information relating to services
to that covered entity. A pharmacy benefits manager
providing information under this paragraph may designate
that material as confidential.__Information designated as
confidential by a pharmacy benefits manager and provided to
a covered entity under this paragraph may not be disclosed
by the covered entity to any person without the consent of
the pharmacy benefits manager, except that disclosure may be
made in a court filing under the Maine Unfair Trade
Practices Act or when authorized by that Act or ordered by a
court of this State for good cause shown.

 
E.__With regard to the dispensation of a substitute
prescription drug for a prescribed drug to a covered
individual the following provisions apply.

 
(1)__The pharmacy benefits manager may substitute a
lower-priced generic and therapeutically equivalent
drug for a higher-priced prescribed drug.

 
(2) With regard to substitutions in which the substitute drug
costs more than the prescribed drug, the substitution must be
made for medical reasons that benefit the covered individual and
must benefit the covered entity.__If a substitution is being made
under this subparagraph, the pharmacy benefits manager shall


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