# COMAR Title 31 — Maryland Insurance Administration

## Subtitle 10 — Health Insurance — General

### Chapter 46 — Pharmacy Benefits Managers — Maximum Allowable Cost

#### Regulation .03 Disclosures to a Contracted Pharmacy.

*COMAR 31.10.46.03*

A. A PBM, whether its contract is directly with a pharmacy or indirectly with a pharmacy through a PSAO or group purchasing organization, shall disclose to a contracted pharmacy at the time of entering into a contract with a pharmacy and at least 30 working days before any contract change for a contracted pharmacy:

  (1) The applicable terms, conditions, and reimbursement rates, including:

    (a) The sources; and

    (b) The terms of the compensation program;

  (2) The process and procedures for verifying pharmacy benefits and beneficiary eligibility;

  (3) The dispute resolution, internal appeal process under Regulation .04 of this chapter, and audit appeals process; and

  (4) The process and procedures for verifying the prescription drugs included on the formularies used by the PBM.

B. A PBM, whether its contract is directly with a pharmacy or indirectly with a pharmacy through a PSAO or group purchasing organization, shall:

  (1) Update its pricing information at least every 7 days;

  (2) Establish a reasonable process by which a contracted pharmacy has access to the current and applicable MAC lists and price list in an electronic format as updated in accordance with the requirements of this section; and

  (3) Immediately after a pricing information update occurs pursuant to this regulation, use the updated pricing information in calculating the payments made to all contracted pharmacies.

C. A claim paid on behalf of a carrier to a contracted pharmacy under a participating pharmacy contract is subject to the requirements of Insurance Article, §§15-1005, 15-1008, 15-1009, and 15-1631, Annotated Code of Maryland.