Section 15-2007 – Review by Commissioner — Expense
(a) Whenever the Commissioner considers it advisable, the Commissioner may examine the affairs, transactions, accounts, and records of a registered pharmacy services administrative organization. (b) The examination shall be conducted in accordance with § 2–207 of this article. (c) The expense of the examination shall be paid in accordance with § 2–208 of this article. (d) The reports of […]
Section 15-2008 – Adoption of Regulations
The Commissioner may adopt regulations to implement this subtitle.
Section 15-1642 – Violations; Enforcement
(a) It is a violation of this subtitle for a pharmacy benefits manager to: (1) misrepresent pertinent facts or policy provisions that relate to a claim or the compensation program at issue in a complaint or an appeal of a decision regarding a complaint; (2) refuse to pay a claim for an arbitrary or capricious reason based on […]
Section 15-2009 – Review Authority Not Diminished
This subtitle may not be construed to diminish the authority of the Office of the Attorney General or the Commissioner to obtain information relating to a pharmacy services administrative organization and use the information in any proceeding.
Section 15-1701 – Definitions
(a) In this subtitle the following words have the meanings indicated. (b) “Carrier” has the meaning stated in § 15–1301 of this title. (c) “Enrollee” means an individual entitled to health care benefits from a carrier. (d) “Physician rating system” means any program that: (1) measures, rates, or tiers the performance of physicians under contract with the carrier; and (2) discloses […]
Section 15-2010 – Filing of Contract or Amendment to Contract
(a) A pharmacy services administrative contract or an amendment to a pharmacy services administrative contract or a contract or an amendment to a contract between a pharmacy services administrative organization, on behalf of an independent pharmacy, and a pharmacy benefits manager or group purchasing organization may not become effective unless: (1) at least 60 days before the […]
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 […]
Section 15-2012 – Disclosure of Ownership or Control to Commissioner — Notification of Changes
(a) Each pharmacy services administrative organization shall disclose to the Commissioner the extent of any ownership or control of the pharmacy services administrative organization by any parent company, subsidiary, or other organization that: (1) provides pharmacy services; (2) provides prescription drug or device services; or (3) manufactures, sells, or distributes prescription drugs, biologics, or medical devices. (b) Each pharmacy services […]