# COMAR Title 31 — Maryland Insurance Administration

## Subtitle 10 — Health Insurance — General

### Chapter 50 — Filing of PSAO Contracts and Amendments

#### Regulation .04 Noncompliant Contract Terms.

*COMAR 31.10.50.04*

A. A PSAO may have a contract form or amendment to a contract form disapproved if the contract or amendment contains or uses any language that:

  (1) Violates Title 15, Subtitle 16 or Subtitle 20 of the Insurance Article, Annotated Code of Maryland or any applicable statutory provisions, including but not limited to Insurance Article, §§15-1611, 15-1628, 15-1628.1, 15-1628.2, 15-1628.3, 15-1629, 15-1631, 15-1633, 15-1634—15-1639, 15-2011, 15-2013(c), 15-2015, and 15-2016, Annotated Code of Maryland;

  (2) Includes a definition of “multisource generic drug” that is inconsistent with COMAR 31.46, or “generic” or “brand name drug” that is inconsistent with Health Occupations Article, §12-504, Annotated Code of Maryland;

  (3) 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;

  (4) Except for instances of error or fraud, allows a PBM or PSAO to re-classify, re-categorize, or re-characterize an adjudicated claim;

  (5) In any way prohibits or restricts a pharmacist or pharmacy from filing a complaint with the Commissioner; and

  (6) Fails to include the internal appeal provisions in the contract.

B. No provisions