<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 10.18.06.07" title_num="10" subtitle_num="18" chapter_num="06" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>Except as provided in §§B and C of this regulation, the Department shall pay a pharmacy in accordance with the procedures of the Medical Assistance Pharmacy Services Program set forth at COMAR 10.09.03.07.</text>
  </paragraph>
  <paragraph num="B.">
    <text>If the Department or the recipient tells the pharmacy that the recipient has or may have third-party insurance coverage to offset some or all of the cost for services provided under MADAP, the pharmacy shall:</text>
    <paragraph num="(1)">
      <text>Bill the third-party payer the pharmacy’s usual and customary charge for the services provided; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Bill the Department for the difference between the pharmacy’s usual and customary charge and the anticipated third-party receipts.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>If the recipient has third-party insurance coverage, the Department shall pay the pharmacy the difference between the pharmacy’s usual and customary charge and the anticipated third-party insurance receipts, not to exceed the amount permitted under COMAR 10.09.03.07F and G.</text>
  </paragraph>
  <paragraph num="D.">
    <text>The Department shall make payments related to MADAP in accordance with any applicable policies and procedures for the administration of federal funds issued pursuant to the Ryan White HIV/AIDS Treatment Extension Act of 2009, and any subsequent modifications to the Act.</text>
  </paragraph>
</regulation>