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<chapter num="48" heading="Pharmacy Benefits Managers — Informational Filing of Contracts and Amendments" title_num="31" subtitle_num="10">
  <regulation prefix="Regulation" num=".01" heading="Applicability and Scope.">
    <text>This chapter applies to the submission of any participating pharmacy contract or amendment required to be filed under Insurance Article, Title 15, Subtitle 16, Annotated Code of Maryland.</text>
  </regulation>
  <regulation prefix="Regulation" num=".02" 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>“Administration” means the Maryland Insurance Administration.</text>
      </paragraph>
      <paragraph num="(2)">
        <text>“Commissioner” means the Maryland Insurance Commissioner.</text>
      </paragraph>
      <paragraph num="(3)">
        <text>“Noncompliant” means a contract or amendment that is not in compliance with Maryland statutes and regulations.</text>
      </paragraph>
      <paragraph num="(4)">
        <text>“Participating pharmacy contract” has the meaning stated in Insurance Article, §15-1601, Annotated Code of Maryland.</text>
      </paragraph>
      <paragraph num="(5)">
        <text>“Working day” means any day that the Maryland Insurance Administration is open for business.</text>
      </paragraph>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".03" heading="Submission Requirements.">
    <paragraph num="A.">
      <text>Pursuant to the requirements of Insurance Article, §15-1628(b), Annotated Code of Maryland, a PBM shall submit to the Commissioner as an informational filing each participating pharmacy contract form and each amendment to a contract form at least 30 days before the contract form or amendment to the contract form is to become effective.</text>
    </paragraph>
    <paragraph num="B.">
      <text>The Commissioner is not required to review the informational filing to evaluate whether a contract form or amendment to a contract form is in violation of Maryland law at the time the informational filing is made.</text>
    </paragraph>
    <paragraph num="C.">
      <text>Unless it is disapproved by the Commissioner, a PBM may use a contract form or amendment to a contract form after it has been filed with the Commissioner and 30 days have passed since the filing was acknowledged by the Commissioner in writing as having been received.</text>
    </paragraph>
    <paragraph num="D.">
      <text>A PBM may not file a contract form or amendment form that has been previously disapproved by the Commissioner.</text>
    </paragraph>
    <paragraph num="E.">
      <text>Nothing in this regulation shortens the time period for notice under Insurance Article, §15-1628(a), Annotated Code of Maryland, which requires a PBM to provide at least 30 working days’ notice before any contract change.</text>
    </paragraph>
    <paragraph num="F.">
      <text>The filing shall include a cover letter which includes the following:</text>
      <paragraph num="(1)">
        <text>A list of the contract forms and amendment forms included in the submission; and</text>
      </paragraph>
      <paragraph num="(2)">
        <text>A brief description of the purpose of each contract form and amendment form included in the submission.</text>
      </paragraph>
    </paragraph>
    <paragraph num="G.">
      <text>Each page of a contract or amendment shall be identified by a form number which is unique to that form. This number shall be printed in the lower left-hand corner of the first page, and no other number shall appear in close proximity to the form number.</text>
    </paragraph>
    <paragraph num="H.">
      <text>A filing made under this chapter shall include a signed certification from a responsible officer of the PBM that, to the best of the officer’s knowledge and belief, the contract forms and amendment forms comply with applicable statutes and regulations.</text>
    </paragraph>
    <paragraph num="I.">
      <text>A PBM may not file a contract form or amendment form before the PBM has successfully registered as a PBM with the Commissioner.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".04" heading="Noncompliant Contract Terms.">
    <paragraph num="A.">
      <text>A PBM may have a contract form or amendment to a contract form disapproved at any time after the contract form or amendment to a contract form has been submitted as part of an informational filing if the contract form or amendment form contains or uses any language that:</text>
      <paragraph num="(1)">
        <text>Violates Insurance Article, Title 15, Subtitle 16, Annotated Code of Maryland, or any applicable statutory provisions, including but not limited to Insurance Article, §§15-112, 15-112.2(a)—(e), 15-123(d), 15-1004, 15-1005, 15-1008(c), 15-1009, 15-1628—15-1628.3, 15-1629, 15-1631, and 15-1633—15-1639, and Health-General Article, §§19-710(s) and (t) and 19-712.2, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(2)">
        <text>Does not disclose the components of the compensation program through which a reimbursement rate is set;</text>
      </paragraph>
      <paragraph num="(3)">
        <text>Includes a definition of “multisource generic drug” that is inconsistent with COMAR 31.10.46, or “generic” or “brand name drug” that is inconsistent with Health Occupations Article, §12-504, Annotated Code of Maryland;</text>
      </paragraph>
      <paragraph num="(4)">
        <text>Allows the PBM to reimburse a covered drug in an amount that differs, including zero, based on the identity of the wholesale distributor used by a contracting pharmacy for acquisition of the covered drug;</text>
      </paragraph>
      <paragraph num="(5)">
        <text>Except for instances of error or fraud, allows the PBM to reclassify, recategorize, or recharacterize an adjudicated claim;</text>
      </paragraph>
      <paragraph num="(6)">
        <text>In any way prohibits or restricts a pharmacist or pharmacy from filing a complaint with the Commissioner; or</text>
      </paragraph>
      <paragraph num="(7)">
        <text>Fails to include the internal appeal provisions in the contract.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>No provisions in Insurance Article, Annotated Code of Maryland, or this chapter may be waived or modified by contract.</text>
    </paragraph>
  </regulation>
  <regulation prefix="Regulation" num=".05" heading="Use of Noncompliant Contract or Amendment.">
    <paragraph num="A.">
      <text>If a PBM uses a contract form or amendment form which becomes effective and the contract form or amendment form is subsequently found by the Commissioner to be noncompliant, the Commissioner may:</text>
      <paragraph num="(1)">
        <text>Issue an order that:</text>
        <paragraph num="(a)">
          <text>Gives notice of the disapproval;</text>
        </paragraph>
        <paragraph num="(b)">
          <text>States a reason for the disapproval; and</text>
        </paragraph>
        <paragraph num="(c)">
          <text>States the effective date of the disapproval in the notice; and</text>
        </paragraph>
      </paragraph>
      <paragraph num="(2)">
        <text>Impose a penalty as provided under Insurance Article, §15-1642, Annotated Code of Maryland.</text>
      </paragraph>
    </paragraph>
    <paragraph num="B.">
      <text>An order under this regulation is subject to a hearing under Insurance Article, §2-210, Annotated Code of Maryland.</text>
    </paragraph>
    <paragraph num="C.">
      <text>A request for a hearing under this regulation does not stay that portion of the order that requires a PBM to cease and desist from the conduct identified in the order.</text>
    </paragraph>
  </regulation>
  <annotations>
    <annotation type="Authority">Insurance Article, §§2-109, 12-203(d)(2), 15-1628, and 15-1642, Annotated Code of Maryland</annotation>
    <annotation type="History" subtype="Administrative History">Effective date: Effective March 23, 2020 (47:6 Md. R. 343)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .02B amended effective February 7, 2022 (49:3 Md. R. 141)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .03 amended effective February 7, 2022 (49:3 Md. R. 141)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .04A amended effective February 7, 2022 (49:3 Md. R. 141)</annotation>
    <annotation type="History" subtype="Administrative History">Regulation .05A amended effective February 7, 2022 (49:3 Md. R. 141)</annotation>
  </annotations>
</chapter>