<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".04" citation="COMAR 31.10.50.04" title_num="31" subtitle_num="10" chapter_num="50" heading="Noncompliant Contract Terms.">
  <paragraph num="A.">
    <text>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:</text>
    <paragraph num="(1)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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;</text>
    </paragraph>
    <paragraph num="(3)">
      <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="(4)">
      <text>Except for instances of error or fraud, allows a PBM or PSAO to re-classify, re-categorize, or re-characterize an adjudicated claim;</text>
    </paragraph>
    <paragraph num="(5)">
      <text>In any way prohibits or restricts a pharmacist or pharmacy from filing a complaint with the Commissioner; and</text>
    </paragraph>
    <paragraph num="(6)">
      <text>Fails to include the internal appeal provisions in the contract.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>No provisions</text>
  </paragraph>
</regulation>