The meeting discussed pharmacy reimbursement issues, specifically the operational challenges pharmacies face when contracting with multiple Managed Care Organizations and Pharmacy Benefit Managers. Key topics included the potential impact of a single PBM model versus a fee-for-service model on patient access, reimbursement adequacy, and the sustainability of independent pharmacies. Participants debated administrative efficiency, the importance of maintaining competition in the program, and the need for standardized practices regarding formularies and prior authorizations to prevent pharmacy deserts and ensure provider viability.
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The public meeting was held to discuss the legislative study mandated by Senate Bill 890 regarding the use and regulation of captive insurance companies in Maryland. The presentation covered the definition and purpose of captive insurance, the differences between captive and commercial insurance, various types of captive structures including single-parent, group, association, and rental captives, and the regulatory environment for these entities. Stakeholder feedback was requested to assist in drafting research and recommendations for the Governor and the General Assembly.
Oct 7, 2026·BoardMeeting
Board
Workgroup to Study the Rise in Adverse Decisions in the State Health Care System Meeting
The workgroup discussed recommendations to address the rise in adverse health care decisions, including enhancements to data collection through the all-payer claims database and the inclusion of standardized reason codes for denial reporting. Key discussion topics also covered the potential for public posting of clinical criteria, strategies for conducting oversight and audits of prior authorization processes, and the application of federal interoperability rules to state-based commercial market plans.
Oct 5, 2026·BoardMeeting
Board
Maryland Insurance Administration and Maryland Health Benefit Exchange Joint Meeting
The meeting featured presentations regarding assistance to small businesses within the small group health insurance market. Discussions covered market trends and data, including historical claims, premium rate increases, and enrollment statistics for both fully insured and self-insured plans. Speakers addressed factors driving cost growth, such as inpatient hospitalizations and prescription drugs, and outlined ongoing efforts to support small businesses through the state exchange.
Extracted from official board minutes, strategic plans, and video transcripts.
