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 […]
Section 15-1704 – Notification of Results of Review; Finding of Noncompliance; Reports
(a) A carrier shall notify the Commissioner of the results of any final review conducted by a ratings examiner of a physician rating system of the carrier within 45 calendar days after receipt of the results by the carrier. (b) If the review conducted by a ratings examiner of a physician rating system of a carrier indicates […]
Section 15-1901 – Definitions
(a) In this subtitle the following words have the meanings indicated. (b) “Carrier” means: (1) an insurer; (2) a nonprofit health service plan; or (3) a health maintenance organization. (c) “Clinically integrated organization” means: (1) a joint venture between a hospital and physicians that: (i) has received an advisory opinion from the Federal Trade Commission or its staff; and (ii) has been established to: […]
Section 15-1902 – Contract Between Carrier and a Clinically Integrated Organization
(a) Notwithstanding any other provision of this article or the Health – General Article, a contract between a carrier and a clinically integrated organization may include a provision to pay: (1) for services associated with the coordination of covered medical services to qualifying individuals; and (2) a bonus, fee–based incentive, bundled fees, or other incentives to promote the […]
Section 15-1903 – Sharing Medical Information
Notwithstanding any other provision of this article or the Health – General Article, a carrier shall share medical information about a qualifying individual with a clinically integrated organization and its members if: (1) the carrier has a written agreement with the clinically integrated organization specifying the type and proposed use of medical information to be shared; […]
Section 15-2001 – Definitions
(a) In this subtitle the following words have the meanings indicated. (b) “Independent pharmacy” means a pharmacy operating within the State that is under common ownership with not more than two other pharmacies. (c) “Pharmacy benefits manager” has the meaning stated in § 15–1601 of this title. (d) “Pharmacy services administrative contract” means a contractual agreement between a pharmacy […]
Section 15-2002 – Registration as Pharmacy Services Administrative Organization — Requirements
(a) On or after July 1, 2021, a pharmacy services administrative organization shall register with the Commissioner as a pharmacy services administrative organization before providing services as a pharmacy services administrative organization in the State to independent pharmacies. (b) An applicant for registration shall: (1) file with the Commissioner an application on the form that the Commissioner provides; […]
Section 15-2003 – Expiration or Renewal of Registration
(a) A pharmacy services administrative organization registration expires on the second September 30 after its effective date unless it is renewed as provided under this section. (b) A pharmacy services administrative organization may renew its registration for an additional 2–year term if the pharmacy services administrative organization: (1) otherwise is entitled to be registered; (2) files with the Commissioner […]
Section 15-2004 – Registration Prerequisite to Agreements or Contracts
A pharmacy services administrative organization that has not registered with the Commissioner may not enter into an agreement or a contract with an independent pharmacy or a pharmacy benefits manager.
Section 15-2005 – Basis of Denial of Registration or Suspension or Revocation
Subject to the applicable hearing provisions of Title 2 of this article, the Commissioner may deny a registration to a pharmacy services administrative organization or refuse to renew, suspend, or revoke the registration of a pharmacy services administrative organization if the pharmacy services administrative organization, or an officer, a director, or an employee of the […]