MD HB321

Excludes nonprofit health maintenance organizations (HMOs) that operate as group models and provide services solely through internal pharmacy operations from the definition of "purchaser" under pharmacy benefits manager regulations

Expands PBM regulations that previously applied only to carriers to now apply to all pharmacy benefits managers regardless of the type of purchaser they serve

Requires the Maryland Insurance Administration to convene a workgroup by January 1, 2026 to review and recommend changes to laws governing PBMs, specialty pharmacies, and antisteering provisions

Maintains existing PBM restrictions including prohibitions on preventing pharmacies from discussing drug prices with patients, requiring use of affiliated pharmacies (except for specialty drugs), and reimbursing pharmacies less than the PBM reimburses itself

Section 1 provisions take effect January 1, 2026; remaining provisions take effect June 1, 2025