Chapter 21. Pharmacists
Regulation .01 Purpose and Scope.LinkCopy Citation
This chapter establishes requirements for individual pharmacists who enroll in the Program.
Regulation .02 Definitions.LinkCopy Citation
A.
In this chapter, the following terms have the meanings indicated.
B.
Terms Defined.
(1)
“Board” means the Maryland Board of Pharmacy.
(2)
“Maryland Medical Assistance Program” means the program of comprehensive medical and other health-related care for indigent and medically indigent individuals.
(3)
“Medication therapy management” services are defined as face-to-face consultations that are structured to reduce the risk of adverse events and ensure optimum therapeutic outcomes for targeted patients through improved medication use with disease-state specific education, counseling, and medication review related to treatments, including drug therapy, laboratory tests, or medical devices provided by licensed and practicing pharmacists.
(4)
“Participant” means an individual who is certified as eligible for, and is receiving, Medical Assistance benefits.
(5)
“Pharmacist” means an individual licensed in good standing to practice pharmacy in the state where the service is provided.
(6)
“Program” means the Maryland Medical Assistance Program.
Regulation .03 Provider Qualifications and Conditions for Participation.LinkCopy Citation
The pharmacist shall meet:
A.
Licensure requirements set forth in COMAR 10.09.36.02;
B.
Conditions for participation set forth in COMAR 10.09.36.03; and
C.
Conditions for their license under the Board of Pharmacy as stated in Health Occupations Article, Title 12, Subtitle 3, Annotated Code of Maryland.
Regulation .04 Covered Services.LinkCopy Citation
The Program covers the following medically necessary services when rendered by a pharmacist:
A.
Services rendered within the pharmacist’s lawful scope of practice as defined by the Board and otherwise covered by the Program in accordance with COMAR 10.09.02.07D; and
B.
Medication therapy management for participants who meet the Department’s clinical criteria.
Regulation .05 Limitations.LinkCopy Citation
The following are not covered:
A.
Pharmacist administered drugs obtained from manufacturers who do not participate in the federal Drug Rebate Program;
B.
Medical supplies usually included in an office visit;
C.
Services not medically necessary;
D.
Investigational and experimental drugs and procedures;
E.
Procedures solely for cosmetic purposes; and
F.
Services denied by Medicare as not medically justified.
Regulation .06 Payment Procedures.LinkCopy Citation
A.
The provider shall adhere to general provider payment procedures established in COMAR 10.09.36.04.
B.
The provider shall be reimbursed in accordance with COMAR 10.09.02.07D.
C.
Effective January 1, 2024, medication therapy management shall be reimbursed at the following rates:
(1)
For the first 8—15 minutes:
(a)
For new patients, $49.67 per unit of service; or
(b)
For established patients, $31.24 per unit of service; and
(2)
For each additional 8—15 minute, $24.54 per unit of service.
D.
Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.06.
Regulation .07 Recovery and Reimbursement.LinkCopy Citation
Recovery and reimbursement are as set forth in COMAR 10.09.36.07.
Regulation .08 Cause for Suspension or Removal and Imposition of Sanctions.LinkCopy Citation
Causes for suspension or removal and imposition of sanctions are as set forth in COMAR 10.09.36.08.
Chapter annotations
Authority: Health-General Article, §§2-104(b), 2-105(b), 15-103, and 15-148(c), Annotated Code of Maryland
History: Effective date: December 31, 2018 (45:26 Md. R. 1242)
History: Regulation .02B amended effective May 1, 2023 (50:8 Md. R. 337); January 6, 2025 (51:26 Md. R. 1187)
History: Regulation .03 amended effective January 6, 2025 (51:26 Md. R. 1187)
History: Regulation .03C, D adopted effective May 1, 2023 (50:8 Md. R. 337)
History: Regulation .04 amended effective May 1, 2023 (50:8 Md. R. 337); January 6, 2025 (51:26 Md. R. 1187)
History: Regulation .05 amended effective January 6, 2025 (51:26 Md. R. 1187)
History: Regulation .06 amended effective June 14, 2021 (48:12 Md. R. 473); May 1, 2023 (50:8 Md. R. 337); January 6, 2025 (51:26 Md. R. 1187)