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§ 15-1634. Authorization required for therapeutic interchange

West's Annotated Code of MarylandInsuranceEffective: October 1, 2008

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 15. Health Insurance
Subtitle 16. Pharmacy Benefits Managers (Refs & Annos)
Part VI. Therapeutic Interchanges
Effective: October 1, 2008
MD Code, Insurance, § 15-1634
§ 15-1634. Authorization required for therapeutic interchange
Currentness
In general
(a) Before making a therapeutic interchange, a pharmacy benefits manager or its agent shall obtain authorization from a prescriber or an individual authorized by the prescriber.
Information disclosed to prescriber
(b) In any therapeutic interchange solicitation, the following shall be disclosed to the prescriber:
(1) that a therapeutic interchange is being solicited;
(2) the circumstances under which the originally prescribed drug will be covered by the purchaser;
(3) the difference in copayments or coinsurance to be paid by the beneficiary to obtain the proposed drug;
(4) the circumstances and extent to which health care costs related to the therapeutic interchange will be compensated; and
(5) any clinically significant differences, as determined by a pharmacy and therapeutics committee of the pharmacy benefits manager, with respect to efficacy, side effects, and potential impact on health and safety.
Claims that therapeutic interchange will save purchaser money
(c) When soliciting a therapeutic interchange from a prescriber, a pharmacy benefits manager or its agent may not make a claim that the therapeutic interchange will save the purchaser money unless the claim can be substantiated.
Disclosure of payments made to pharmacy benefits manager or agent
(d) If the pharmacy benefits manager or its agent receives payment for making a therapeutic interchange from a pharmaceutical manufacturer or other person, including the pharmacy benefits manager, that is not reflected in cost savings to the purchaser, the existence of the payment shall be communicated to the prescriber at the time of the therapeutic interchange solicitation.

Credits

Added by Acts 2008, c. 203, § 1, eff. Oct. 1, 2008; Acts 2008, c. 204, § 1, eff. Oct. 1, 2008.
MD Code, Insurance, § 15-1634, MD INSURANCE § 15-1634
Current through legislation effective through April 25, 2024, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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