<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".18" citation="COMAR 10.11.03.18" title_num="10" subtitle_num="11" chapter_num="03" heading="Billing Procedures for Pharmacy Services.">
  <paragraph num="A.">
    <text>A pharmacy provider shall comply with all procedures listed in Regulation .13 of this chapter.</text>
  </paragraph>
  <paragraph num="B.">
    <text>A pharmacy provider shall:</text>
    <paragraph num="(1)">
      <text>Upon request, produce records to verify any charge to the CMS Program; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Charge the CMS Program the usual and customary charge to the general public for similar prescriptions.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Determination of allowable cost for multiple source drugs designated by the Centers for Medicare and Medicaid Services of the Department of Health and Human Services or for each drug listed in the formulary allowable cost shall be the lowest of the maximum allowable cost.</text>
  </paragraph>
  <paragraph num="D.">
    <text>Payment for covered services to a pharmacy shall be made as follows:</text>
    <paragraph num="(1)">
      <text>Payment for formulary drug preparation shall be the:</text>
      <paragraph num="(a)">
        <text>Least expensive available; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Allowable cost according to the State Title XIX Agency;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Payment for over-the-counter drugs is not covered except in extenuating circumstances at the discretion of the CMS Program.</text>
    </paragraph>
  </paragraph>
</regulation>