Maryland Statutes
Title 15 - Health Insurance
Subtitle 16 - Pharmacy Benefits Managers

Part I - Definitions

Section 15-1601 - Definitions - (a) In this subtitle the following words have the meanings...

Part II - Registration and Regulation of Pharmacy Benefits Managers

Section 15-1604 - Registration - (a) A pharmacy benefits manager shall register with the Commissioner...

Section 15-1605 - Expiration; Renewal - (a) A pharmacy benefits manager registration expires on the second...

Section 15-1606 - Agreements With Unregistered Pharmacy Benefits Managers Prohibited - A carrier may not enter into an agreement with a...

Section 15-1607 - Denials, Suspensions, Revocations, and Refusals to Renew - (a) Subject to the applicable hearing provisions of Title 2...

Section 15-1608 - Books and Records - A pharmacy benefits manager shall maintain adequate books and records...

Section 15-1609 - Examinations - (a) Whenever the Commissioner considers it advisable, the Commissioner may...

Section 15-1610 - Delivery Through Nonresident Pharmacies - A pharmacy benefits manager may not ship, mail, or deliver...

Section 15-1611 - Information on and Sales of Prescription Drugs - (a) This section applies only to a pharmacy benefits manager...

Section 15-1611.1 - Choice of Pharmacy by Beneficiary to Fill Prescription - (a) This section applies only to a pharmacy benefits manager...

Section 15-1612 - Reimbursement for Pharmaceutical Product or Pharmacist Service - (a) This section applies only to a pharmacy benefits manager...

Part III - Pharmacy and Therapeutics Committees

Section 15-1613 - In General - A pharmacy and therapeutics committee established by a pharmacy benefits...

Section 15-1614 - Composition; Conflict of Interest Statement - (a) (1) A pharmacy and therapeutics committee shall: (i) include...

Section 15-1615 - Mandatory Participation on Committee Prohibited - A pharmacy benefits manager may not require a pharmacist to...

Section 15-1616 - Disclosure About Composition - On request of a purchaser for which the pharmacy and...

Section 15-1617 - Required Policies, Procedures, and Processes - A pharmacy benefits manager shall ensure that its pharmacy and...

Section 15-1618 - Accreditation - The Commissioner may consider a pharmacy and therapeutics committee of...

Section 15-1619 - Regulations - The Commissioner may adopt regulations to implement this part.

Part IV - Disclosures to Purchasers

Section 15-1622 - Scope of Part - (a) Except as provided for in subsection (b) of this...

Section 15-1623 - Requirements Before Entering Into Contract - (a) Before entering into a contract with a purchaser, a...

Section 15-1624 - Rebate Sharing Contract - (a) If a purchaser has a rebate sharing contract, a...

Section 15-1625 - Effect of Part - This part does not diminish the authority of the Office...

Part V - Contracts With Pharmacies and Pharmacists; Audits

Section 15-1628 - Required Disclosures by Pharmacy Benefits Manager; Filing Requirements for Contract or Amendment to Contract - (a) For disputes regarding cost pricing and reimbursement under a...

Section 15-1628.1 - Maximum Allowable Cost Pricing Between Pharmacy Benefits Manager and Contracted Pharmacy - (a) (1) In this section the following words have the...

Section 15-1628.3 - Fee or Performance-Based Reimbursement Related to Claim Adjudication - (a) A pharmacy benefits manager or a carrier may not...

Section 15-1629 - Audits by Pharmacy Benefits Manager - (a) This section applies only to a pharmacy benefits manager...

Section 15-1630 - Internal Review Process - (a) This section applies only to a pharmacy benefits manager...

Section 15-1631 - Retroactive Denial or Modification of Reimbursement for Approved Claim - Except for an overpayment as defined in § 15–1629(h) of...

Part VI - Therapeutic Interchanges

Section 15-1633 - When Request Allowed - A pharmacy benefits manager or its agent may not request...

Section 15-1634 - Authorization; Disclosures; Money-Saving Claims; Payment for Interchange - (a) Before making a therapeutic interchange, a pharmacy benefits manager...

Section 15-1635 - Requirements When Interchange Occurs - If a therapeutic interchange occurs, the pharmacy benefits manager or...

Section 15-1636 - Cancellation and Reversal - (a) A pharmacy benefits manager or its agent shall cancel...

Section 15-1637 - Maintenance of Toll-Free Telephone Number - (a) A pharmacy benefits manager shall maintain a toll–free telephone...

Section 15-1638 - Privacy Standards - All disclosures made under this part shall comply with the...

Section 15-1639 - Policies and Procedures - A pharmacy benefits manager shall establish appropriate policies and procedures...

Part VII - Penalties

Section 15-1642 - Violations; Enforcement - (a) It is a violation of this subtitle for a...