Section 15-2006 – Recordkeeping Requirements
A pharmacy services administrative organization shall maintain adequate books and records regarding each independent pharmacy for which the pharmacy services administrative organization provides services as a pharmacy services administrative organization: (1) in accordance with prudent standards of record keeping; (2) for the duration of the agreement between the pharmacy services administrative organization and the independent pharmacy; and […]
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 […]