<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".05" citation="COMAR 31.10.49.05" title_num="31" subtitle_num="10" chapter_num="49" heading="Compliant Process.">
  <paragraph num="A.">
    <text>Prior to filing a complaint with the Commissioner, a contracted pharmacy or its designee shall exhaust the internal appeal process established by the PSAO.</text>
  </paragraph>
  <paragraph num="B.">
    <text>A complaint is properly completed and may be filed if a contracted pharmacy or designee for the pharmacy:</text>
    <paragraph num="(1)">
      <text>Completes all applicable portions of the Commissioner’s complaint form; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Provides a copy of the relevant contract or the provisions that are related to the internal dispute, including but not limited to any applicable remittance and copy of any appeal decision.</text>
    </paragraph>
  </paragraph>
  <paragraph num="C.">
    <text>Notification of the complaint to the PSAO.</text>
    <paragraph num="(1)">
      <text>Upon receipt of a completed complaint form, the Commissioner shall provide a copy to the PSAO.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Within 15 working days of receiving the Commissioner’s notice, the PSAO shall provide the Commissioner with:</text>
      <paragraph num="(a)">
        <text>A complete, unredacted copy of the applicable portion of the pharmacy services administrative contract relating to the complaint filed with the Commissioner, including any other contract applicable to the complaint; and</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Any other information the Commissioner may require for the purposes of determining a PSAO’s compliance with:</text>
        <paragraph num="(i)">
          <text>The Insurance Article, Annotated Code of Maryland;</text>
        </paragraph>
        <paragraph num="(ii)">
          <text>This chapter; or</text>
        </paragraph>
        <paragraph num="(iii)">
          <text>The applicable terms of the applicable pharmacy services administrative contract, PBM contract, or applicable purchaser’s contract.</text>
        </paragraph>
      </paragraph>
    </paragraph>
  </paragraph>
</regulation>