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MaineLD 378132nd Maine Legislature (2025-2026)SenateWALLET

An Act to Clarify That Health Insurers Must Comply with Plan Sponsors' Statutory Rights to Audit Claims and Data Requests Related to Those Audits

Sponsored By: Donna Bailey (Democratic)

Became Law

HEALTH CARE SERVICESHEALTH CARE SERVICES - DELIVERY

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Bill Overview

Analyzed Economic Effects

5 provisions identified: 2 benefits, 1 costs, 2 mixed.

PBMs must share rebates and claims data

Beginning April 13, 2026, plan sponsors can audit a PBM once each year, at least six months apart. Within 30 business days, the PBM must give rebate amounts by drug and therapeutic class, pharmacy claims, payment files, and all other contract revenue and fees. Data can go to the sponsor or its designated business associate, if allowed by law. Redactions are allowed only to follow HIPAA and HITECH.

Stronger audit rights over plan administrators

Beginning April 13, 2026, plan sponsors can run one post‑payment audit each year, at least six months apart. Administrators must deliver claims, payment, fee, and discount data within 30 business days. Data can go to the sponsor or its designated business associate, if allowed by law. The law also widens who counts as an administrator, so more third parties must share this data.

Fully insured employers lose audit rights

Beginning April 13, 2026, employers with fully insured plans are not treated as plan sponsors under this law. They cannot use these audit and disclosure rights. The audit rules focus on self‑funded and other non‑fully‑insured plans.

Confidentiality and breach rules for plan audits

Starting April 13, 2026, administrators may require a nondisclosure and data‑use agreement before giving audit data. Any required cybersecurity or liability insurance cannot exceed the administrator’s contract liability limit. Administrators can refuse data to auditors who breach or refuse the agreement. Plan sponsors and their business associates must notify the administrator right away if they discover a data breach.

NDA and breach rules for PBM audits

Starting April 13, 2026, a PBM can require a nondisclosure and data‑use agreement before sharing audit data. Any required cybersecurity or liability insurance cannot be higher than the PBM’s contract liability limit. PBMs can refuse data to auditors who breach or refuse the agreement. Plan sponsors and their business associates must notify the PBM right away if they discover a data breach.

Sponsors & Cosponsors

Sponsor

  • Donna Bailey

    Democratic • Senate

Cosponsors

There are no cosponsors for this bill.

Roll Call Votes

No roll call votes available for this bill.

Actions Timeline

  1. ACTPUB Chapter 652

    5/1/2026

  2. PASSED TO BE ENACTED - Emergency - 2/3 Elected Required, in concurrence.

    4/7/2026Senate

  3. This being an emergency measure, a two-thirds vote of all the members elected to the House was necessary.PASSED TO BE ENACTED.Sent for concurrence. ORDERED SENT FORTHWITH.

    4/7/2026House

  4. CONSENT CALENDAR - FIRST DAYUnder suspension of the rules CONSENT CALENDAR - SECOND DAY.The Bill was PASSED TO BE ENGROSSED as Amended by Committee Amendment "A" (S-624).In concurrence. ORDERED SENT FORTHWITH.

    4/6/2026House

  5. Report READ and ACCEPTED.READ ONCE.Committee Amendment "A" (S-624) READ and ADOPTED.Under suspension of the Rules, READ A SECOND TIME and PASSED TO BE ENGROSSED AS AMENDED BY Committee Amendment "A" (S-624).Ordered sent down forthwith for concurrence.

    4/6/2026Senate

  6. CARRIED OVER, in the same posture, to any special or regular session of the 132nd Legislature, pursuant to Joint Order SP 800.

    6/25/2025Senate

  7. CARRIED OVER, in the same posture, to the next special or regular session of the 132nd Legislature, pursuant to Joint Order SP 519.

    3/21/2025Senate

  8. The Bill was REFERRED to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES.In concurrence. ORDERED SENT FORTHWITH.

    2/4/2025House

  9. Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES suggested and ordered printed REFERENCE to the Committee on HEALTH COVERAGE, INSURANCE AND FINANCIAL SERVICES Ordered sent down forthwith for concurrence

    2/4/2025Senate

Bill Text

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