<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".02" citation="COMAR 31.10.46.02" title_num="31" subtitle_num="10" chapter_num="46" heading="Definitions.">
  <paragraph num="A.">
    <text>In this chapter, the following terms have the meanings indicated.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Terms Defined.</text>
    <paragraph num="(1)">
      <text>“Appeal decision” means a written or electronic notice issued by a PBM in response to an appeal filed by a contracted pharmacy of the maximum allowable cost used to adjudicate a claim.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>“Beneficiary” means an individual who receives prescription drug coverage or benefits from a purchaser.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>“Carrier” has the meaning stated in Insurance Article §15-1601, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(4)">
      <text>“Compensation program” has the meaning stated in Insurance Article §15-1601, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(5)">
      <text>“Contracted pharmacy” has the meaning stated in Insurance Article, §15-1601, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>“MAC complaint” means a communication by a contracted pharmacy that disputes the appeal decision, and is submitted on a MAC complaint form to the Commissioner, after the pharmacy benefits manager’s internal appeal process has been exhausted as required by Insurance Article, §15-1628.1(f), Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(7)">
      <text>“MAC complaint form” means the form adopted by the Commissioner under Regulation .05 of this chapter.</text>
    </paragraph>
    <paragraph num="(8)">
      <text>“MAC list” means a list of multisource generic drugs, medical products, and devices for which a MAC has been established by a pharmacy benefits manager or a purchaser.</text>
    </paragraph>
    <paragraph num="(9)">
      <text>“Maximum allowable cost” or “MAC” has the meaning stated in Insurance Article, §15-1628.1, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(10)">
      <text>“Multisource generic drug” means a generic drug as defined in Health-General Article, §21-2C-01(f), Annotated Code of Maryland, for which there is at least one other drug and does not include a brand name drug as that term is defined in Health Occupations, §12-504, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(11)">
      <text>“Participating pharmacy contract” means a contract filed with the Commissioner that is:</text>
      <paragraph num="(a)">
        <text>Between a pharmacy and a:</text>
        <paragraph num="(i)">
          <text>Pharmacy benefits manager;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>Pharmacy services administrative organization; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>Group purchasing organization;</text>
        </paragraph>
      </paragraph>
      <paragraph num="(b)">
        <text>Filed as required by the Commissioner;</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Not disapproved by the Commissioner; and</text>
      </paragraph>
      <paragraph num="(d)">
        <text>In compliance with the requirements stated in this chapter.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(12)">
      <text>“Pharmacist” has the meaning stated in Health Occupations Article, §12–101, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(13)">
      <text>“Pharmacy” has the meaning stated in Health Occupations Article, §12–101, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(14)">
      <text>“Pharmacy benefits management services” has the meaning stated in Insurance Article, §15-1601, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(15)">
      <text>“Pharmacy benefits manager” or “PBM” has the meaning stated in Insurance Article, §15-1601, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(16)">
      <text>“Pharmacy services administration organization” or “PSAO” means an entity that provides a contracted pharmacy with contracting administrative services relating to prescription drug benefits.</text>
    </paragraph>
    <paragraph num="(17)">
      <text>“Pricing information” means anything used in the mathematical calculation to determine the payment to a contracted pharmacy.</text>
    </paragraph>
    <paragraph num="(18)">
      <text>“Purchaser” has the meaning stated in Insurance Article, §15-1601, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="(19)">
      <text>“Source” means the publisher or publishers stated in the participating pharmacy contract, used by the PBM, in any manner, to establish the basis of the PBM’s MAC reimbursement amount to a contracted pharmacy, under a participating pharmacy contract compensation program.</text>
    </paragraph>
    <paragraph num="(20)">
      <text>“Working day” means any day that the Maryland Insurance Administration is open for business.</text>
    </paragraph>
  </paragraph>
</regulation>