ME LD1906

Plan sponsors of self-funded health plans gain the right to audit claims data from health plan administrators and pharmacy benefits managers (PBMs) at least once per calendar year, with administrators required to provide requested information within 30 business days.

High-cost claims exceeding $100,000 must be disclosed to plan sponsors upon request within 2 business days of claim receipt, including itemized billing statements and medical records, to allow pre-payment audits.

PBMs must disclose to plan sponsors the actual amounts paid to pharmacies, rebates by drug and therapeutic category, and all other revenue and fees derived from contracts including direct or indirect remuneration from pharmaceutical manufacturers.

Administrators and PBMs cannot impose audit fees exceeding direct expenses or restrict audit scope regarding time period, number of claims, type of analysis, or choice of auditor, though audit requests must be made within 24 months of plan year end.

Contracts entered into, amended, or renewed on or after January 1, 2026 cannot contain provisions violating these requirements, with violations enforced under the Maine Unfair Trade Practices Act.