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§ 15-118. Prescription drugs; use, reimbursement

West's Annotated Code of MarylandHealth--General

West's Annotated Code of Maryland
Health--General
Title 15. Assistance Programs (Refs & Annos)
Subtitle 1. Medical and Pharmacy Assistance Programs (Refs & Annos)
MD Code, Health - General, § 15-118
§ 15-118. Prescription drugs; use, reimbursement
Currentness
Generic drugs
(a)(1) Unless the prescriber directs otherwise on the form or on an attached signed certification of need, the generic form of the drug authorized under § 12-504 of the Health Occupations Article shall be used to fill the prescription.
(2) If the appropriate generic drug is not generally available, the Department may waive the requirement for generic substitution under paragraph (1) of this subsection.
Reimbursement levels
(b)(1) Except as provided under paragraph (2) of this subsection, the Program shall establish maximum reimbursement levels for the drug products for which there is a generic equivalent authorized under § 12-504 of the Health Occupations Article, based on the cost of the generic product.
(2) If a prescriber directs a specific brand name drug, the reimbursement level shall be based on the cost of the brand name product.
Changes in rules or requirements
(c)(1) Except as provided under paragraph (4) of this subsection and unless the change is made by an emergency regulation, the Program shall notify all pharmacies under contract with the Program in writing of changes in the Pharmaceutical Benefit Program rules or requirements at least 30 days before the change is effective.
(2) Changes that require 30 days' advance written notice under paragraph (1) of this subsection are:
(i) Exclusion of coverage for classes of drugs as specified by contract;
(ii) Changes in prior or preauthorization procedures; and
(iii) Selection of new prescription claims processors.
(3) If the Program fails to provide advance notice as required under paragraph (1) of this subsection, it shall honor and pay in full any claim under the Program rules or requirements that existed before the change for 30 days after the postmarked date of the notice.
(4) Notwithstanding any other provision of law, the notice requirements of this subsection do not apply to the addition of new generic drugs authorized under § 12-504 of the Health Occupations Article.
Regulations
(d) The Secretary shall adopt regulations to carry out the provisions of this section.
Exceptions
(e) Except for a prescription for a prescription drug that contains a substance listed in Schedule II or that is determined by the Secretary to present an emerging threat in the State because of increasing abuse or diversion, the provisions of § 21-220(b)(1) of this article shall apply to the Program.

Credits

Added by Acts 1982, c. 21, § 2, eff. July 1, 1982. Amended by Acts 1988, c. 126, § 1, eff. July 1, 1988; Acts 1992, c. 521, § 1, eff. Oct. 1, 1992; Acts 1996, c. 102, § 1, eff. July 1, 1996; Acts 1997, c. 14, § 20, eff. April 8, 1997; Acts 2006, c. 264, § 1, eff. Oct. 1, 2006.
Formerly Art. 43, § 42.
MD Code, Health - General, § 15-118, MD HEALTH GEN § 15-118
Current with legislation effective through October 1, 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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