Section 15-2013 – Disclosure of Ownership or Control to Independent Pharmacy — Notification of Changes
(a) Before entering into a pharmacy services administrative contract, a pharmacy services administrative organization shall provide to an independent pharmacy a written disclosure of ownership or control. (b) The disclosure required under subsection (a) of this section shall include the extent of any ownership or control by any parent company, subsidiary, or other organization that: (1) provides pharmacy […]
Section 15-2014 – Disclosure of Ownership or Control to Purchaser or Pharmacy Benefits Manager — Notification of Changes
(a) Before entering into a contract with a purchaser or pharmacy benefits manager, a pharmacy services administrative organization shall provide to the purchaser or pharmacy benefits manager a written disclosure of ownership or control. (b) The disclosure required under subsection (a) of this section shall include the extent of any ownership or control by any parent company, […]
Section 15-2015 – Timely Submission of Remittances
A pharmacy services administrative contract shall: (1) require all remittances for claims submitted by a pharmacy benefits manager or purchaser on behalf of an independent pharmacy to be passed by the pharmacy services administrative organization to the independent pharmacy within a reasonable amount of time; and (2) specify the reasonable amount of time in which the pharmacy […]
Section 15-2016 – Certain Contractual Requirements Prohibited — Certain Disclosures to Commissioner
(a) A pharmacy services administrative organization that owns or is owned by, in whole or in part, an entity that manufactures, sells, or distributes prescription drugs, biologics, or medical devices may not require, as a condition of entering into a pharmacy services administrative contract, that an independent pharmacy purchase any drugs, biologics, or medical devices from […]
Section 15-2017 – Confidentiality of Disclosures
(a) All disclosures made under this subtitle shall comply with the privacy standards established in federal and State law. (b) A contract or amendment to a contract submitted to the Commissioner as required by this subtitle: (1) is considered to be confidential and proprietary information; and (2) is not subject to disclosure under the Public Information Act.
Section 15-2018 – Implementation Policies and Procedures
A pharmacy services administrative organization shall establish appropriate policies and procedures to implement the requirements of this subtitle.
Section 15-2019 – Pharmacy Services Administrative Organization Prohibited From Certain Actions — Violations and Penalties — Service of Notices — Regulatory Authority
(a) A pharmacy services administrative organization may not: (1) misrepresent pertinent facts or policy provisions that relate to an issue in a dispute or an appeal of a decision regarding a dispute; (2) refuse to pay or reimburse an independent pharmacy for an arbitrary or capricious reason based on all available information; (3) fail to settle a dispute promptly […]
Section 15-1702 – General Consideration
(a) A carrier may not use a physician rating system unless the physician rating system is approved by a ratings examiner. (b) A carrier shall contract with and pay for a ratings examiner to review any physician rating system of the carrier. (c) A physician rating system of a carrier is deemed to meet the requirements of this […]
Section 15-2011 – Provision of Certain Documents by Pharmacy Services Administrative Organization — Confidential
(a) A pharmacy services administrative contract shall include a provision that requires the pharmacy services administrative organization to provide to the independent pharmacy a copy of any contracts, amendments, payment schedules, or reimbursement rates within 5 working days after the execution of a contract, or an amendment to a contract, signed on behalf of the independent […]
Section 15-1703 – Appeals Process
(a) A carrier that uses a physician rating system shall: (1) establish an appeals process for physicians to use to contest their rating; and (2) at least 45 days before making available to enrollees any new or revised quality of performance or cost–efficiency evaluations or any new or revised inclusions or exclusions from a physician rating system, provide […]