<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".03" citation="COMAR 31.10.46.03" title_num="31" subtitle_num="10" chapter_num="46" heading="Disclosures to a Contracted Pharmacy.">
  <paragraph num="A.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>The applicable terms, conditions, and reimbursement rates, including:</text>
      <paragraph num="(a)">
        <text>The sources; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The terms of the compensation program;</text>
      </paragraph>
    </paragraph>
    <paragraph num="(2)">
      <text>The process and procedures for verifying pharmacy benefits and beneficiary eligibility;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The dispute resolution, internal appeal process under Regulation .04 of this chapter, and audit appeals process; and</text>
    </paragraph>
    <paragraph num="(4)">
      <text>The process and procedures for verifying the prescription drugs included on the formularies used by the PBM.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>A PBM, whether its contract is directly with a pharmacy or indirectly with a pharmacy through a PSAO or group purchasing organization, shall:</text>
    <paragraph num="(1)">
      <text>Update its pricing information at least every 7 days;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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</text>
    </paragraph>
    <paragraph num="(3)">
      <text>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.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>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.</text>
  </paragraph>
</regulation>