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§ 15-1628. Disclosure of information to pharmacy or pharmacist

West's Annotated Code of MarylandInsuranceEffective: October 1, 2022

West's Annotated Code of Maryland
Insurance (Refs & Annos)
Title 15. Health Insurance
Subtitle 16. Pharmacy Benefits Managers (Refs & Annos)
Part V. Contracts with Pharmacies and Pharmacists; Audits
Effective: October 1, 2022
MD Code, Insurance, § 15-1628
§ 15-1628. Disclosure of information to pharmacy or pharmacist
Currentness
In general
(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.
Contract or amendment to contract submitted to Commissioner
(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.

Credits

Added by Acts 2008, c. 262, § 1, eff. Oct. 1, 2008. Amended by Acts 2019, c. 400, § 1, eff. May 13, 2019; Acts 2020, c. 455, § 1, eff. Jan. 1, 2021; Acts 2021, c. 358, § 1, eff. Jan. 1, 2022; Acts 2022, c. 307, § 1, eff. Oct. 1, 2022; Acts 2022, c. 308, § 1, eff. Oct. 1, 2022.
MD Code, Insurance, § 15-1628, MD INSURANCE § 15-1628
Current through legislation effective through April 9, 2023, from the 2024 Regular Session of the General Assembly. Some statute sections may be more current, see credits for details.
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