<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".08" citation="COMAR 10.14.02.08" title_num="10" subtitle_num="14" chapter_num="02" heading="Pharmacy Services.">
  <paragraph num="A.">
    <text>To be considered a participating pharmacy in the Program, the provider shall:</text>
    <paragraph num="(1)">
      <text>Obtain a permit from the Department pursuant to Health Occupations Article, Title 12, Annotated Code of Maryland;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Agree to abide by the provisions set forth in this regulation by signing and sending to the Department the designated Departmental form;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Agree to accept, as payment in full, the amount paid by the Program pursuant to §E of this regulation plus the amount paid by the eligible patient's health insurer, if applicable;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Agree not to bill an eligible patient for an additional charge for the reimbursed pharmacy services provided; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Maintain adequate prescription and administrative records for a minimum of 5 years and, upon request, allow the Department access to the records.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>Reimbursed pharmacy services include but are not limited to the following:</text>
    <paragraph num="(1)">
      <text>A prescription, when ordered and signed by a prescriber for an eligible patient, within the limits established by the Program which includes:</text>
      <paragraph num="(a)">
        <text>A legend drug, including but not limited to the following drug classifications:</text>
        <paragraph num="(i)">
          <text>Analgesic;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Antidepressant;</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Antiemetic;</text>
        </paragraph>
        <paragraph num="(iv)">
          <text>Anti-infective;</text>
        </paragraph>
        <paragraph num="(v)">
          <text>Antineoplastic agent;</text>
        </paragraph>
        <paragraph num="(vi)">
          <text>Benzodiazepine;</text>
        </paragraph>
        <paragraph num="(vii)">
          <text>Colony stimulating factor;</text>
        </paragraph>
        <paragraph num="(viii)">
          <text>Hormone; and</text>
        </paragraph>
        <paragraph num="(ix)">
          <text>Individual vitamin; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>An especially formulated enteral or parenteral nutritional preparation required for a patient with a documented pathologic condition, when treatment is medically necessary and life sustaining;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>Hypodermic needle and syringe;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Over-the-counter iron preparation;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Durable medical equipment as specified in Regulation .10B of this chapter; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>A disposable medical supply as specified in Regulation .10B of this chapter.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Non-reimbursed pharmacy services include but are not limited to:</text>
    <paragraph num="(1)">
      <text>An over-the-counter drug, excluding iron preparations;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>A legend drug for which federal finance participation is prohibited pursuant to 42 CFR §441.25;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>An experimental drug; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>A drug not directly related to the diagnosis and treatment of breast or cervical cancer or a complication of treatment for breast or cervical cancer.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The participating pharmacy responsibilities are as follows:</text>
    <paragraph num="(1)">
      <text>Monitoring an eligible patient’s file for contraindications and toxicity; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Submitting a bill on the designated Departmental form for the reimbursed:</text>
      <paragraph num="(a)">
        <text>Medication;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Durable medical equipment; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Disposable medical supply.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="E.">
    <text>The Department shall reimburse the participating pharmacy:</text>
    <paragraph num="(1)">
      <text>Pursuant to COMAR 10.09.03.07A—G, H(1)—(3), and (5)—(6); and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>For the deductible or patient contribution amount, or both.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The participating pharmacy shall obtain recovery pursuant to COMAR 10.09.03.08.</text>
  </paragraph>
  <paragraph num="G.">
    <text>Periodic peer review may be performed by the Department or its designee.</text>
  </paragraph>
  <paragraph num="H.">
    <text>Except as provided in §I of this regulation, a drug manufacturer shall pay drug rebates to the Department for reimbursable pharmacy services in the same manner and amount that rebates are provided to the State for State-Only and Pharmacy Assistance recipients' purchases of drugs in accordance with §1927(c) of Title XIX of the Social Security Act (42 U.S.C. §1396r-8(c)) which is incorporated by reference.</text>
  </paragraph>
  <paragraph num="I.">
    <text>Limitations.</text>
    <paragraph num="(1)">
      <text>The Department shall provide notice to a drug manufacturer who fails to provide adequate rebates in accordance with this chapter indicating that the manufacturer shall pay the drug rebate unless:</text>
      <paragraph num="(a)">
        <text>The manufacturer submits a written request to the Secretary for a waiver of the rebate requirement; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The Secretary grants a waiver under §I(2) of this regulation.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The Secretary shall grant a waiver to the requirement set forth in §H of this regulation only if the Secretary determines that the drug manufacturer has demonstrated that:</text>
      <paragraph num="(a)">
        <text>The drug is a single source drug or an innovator multiple source drug;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The Department has determined that the drug is essential to the health of the eligible patient;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>The drug has been given a rating of I-A by the Food and Drug Administration; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>The physician has obtained the Department's authorization for use of the drug before prescribing the drug to the eligible patient.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(3)">
      <text>No manufacturer or its designee may dispute or request repayment of any rebate paid under §H of this regulation more than 3 years after the date the rebate was paid.</text>
    </paragraph>
  </paragraph>
  <paragraph num="J.">
    <text>Except when a manufacturer has been granted a waiver to the rebate requirement under §I of this regulation, the Program may not pay for a drug under this chapter if the manufacturer has not provided a rebate to the Program in accordance with §H of this regulation.</text>
  </paragraph>
</regulation>