Md. Code Ann., Ins. § 15-1628
Redline — January 1, 2020 → current.View current text →
Current — January 1, 2023
As of January 1, 2020
(a) At the time of entering into a contract with a pharmacy or a pharmacist, and at least 30 working days before any contract change, a pharmacy benefits manager shall disclose to the pharmacy or pharmacist: (1) the applicable terms, conditions, and reimbursement rates; (2) the process and procedures for verifying pharmacy benefits and beneficiary eligibility; (3) the dispute resolution and audit appeals process; and (4) the process and procedures for verifying the prescription drugs included on the formularies used by the pharmacy benefits manager.
(a) (1) At the time of entering into a contract with a pharmacy or a pharmacist, and at least 30 working days before any contract change, a pharmacy benefits manager shall disclose to the pharmacy or pharmacist: (i) the applicable terms, conditions, and reimbursement rates; (ii) the process and procedures for verifying pharmacy benefits and beneficiary eligibility; (iii) the dispute resolution and audit appeals process; and (iv) the process and procedures for verifying the prescription drugs included on the formularies used by the pharmacy benefits manager. (2) (i) This paragraph does not apply to a requirement that a specialty pharmacy obtain national certification to be considered a specialty pharmacy in a pharmacy benefits manager’s or carrier’s network. (ii) For purposes of credentialing a pharmacy or a pharmacist as a condition for participating in a pharmacy benefits manager’s network for a carrier, the pharmacy benefits manager may not: 1. require a pharmacy or pharmacist to renew credentialing more frequently than once every 3 years; or 2. charge a pharmacy or pharmacist a fee for the initial credentialing or renewing credentialing.
(b) (1) A contract or an amendment to a contract between a pharmacy benefits manager, a pharmacy services administration organization, or a group purchasing organization and a pharmacy may not become effective unless: (i) at least 30 days before the contract or amendment is to become effective, the pharmacy benefits manager, pharmacy services administration organization, or group purchasing organization files the contract or amendment with the Commissioner in the form required by the Commissioner; and (ii) the Commissioner does not disapprove the filing within 30 days after the contract or amendment is filed. (2) The Commissioner shall adopt regulations to establish the circumstances under which the Commissioner may disapprove a contract.
(b) (1) Each contract form or an amendment to a contract form between a pharmacy benefits manager and a pharmacy or a pharmacy services administrative organization, as defined in § 15–2001 of this title, acting on behalf of a pharmacy may not become effective unless at least 30 days before the contract form or amendment to the contract form is to become effective, the pharmacy benefits manager files an informational filing with the Commissioner in the manner required by the Commissioner that includes a copy of the contract form or amendment to the contract form.
(2) The Commissioner is not required to review the informational filing to evaluate whether a contract form or amendment to a contract form is in violation of this subtitle at the time the informational filing is made.
(3) The Commissioner may review and disapprove a contract form or amendment to a contract form at any time after the contract form or amendment to the contract form has been submitted as part of an informational filing.
Official source: Maryland General Assembly. Reproduced from public-domain Maryland statutes; confirm against the official source for the current text. Not legal advice.