Regulation .03 Disclosures to a Contracted Pharmacy.
Regulation .03 Disclosures to a Contracted Pharmacy.LinkCopy Citation
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 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.