Section 15-1630 – Internal Review Process
(a) This section applies only to a pharmacy benefits manager that provides pharmacy benefits management services on behalf of a carrier. (b) A pharmacy benefits manager shall establish a reasonable internal review process for a pharmacy to request the review of a failure to pay the contractual reimbursement amount of a submitted claim. (c) A pharmacy may request […]
Section 15-1613 – In General
A pharmacy and therapeutics committee established by a pharmacy benefits manager performing pharmacy benefits management services on behalf of a carrier shall meet the requirements of this part.
Section 15-1614 – Composition; Conflict of Interest Statement
(a) (1) A pharmacy and therapeutics committee shall: (i) include clinical specialists that represent the needs of a purchaser’s beneficiaries; and (ii) include at least one practicing pharmacist and one practicing physician who are independent of any developer or manufacturer of prescription drugs. (2) A majority of the members of a pharmacy and therapeutics committee shall be practicing physicians or […]
Section 15-1615 – Mandatory Participation on Committee Prohibited
A pharmacy benefits manager may not require a pharmacist to participate on its pharmacy and therapeutics committee.
Section 15-1616 – Disclosure About Composition
On request of a purchaser for which the pharmacy and therapeutics committee makes recommendations, a pharmacy benefits manager shall disclose information about the composition of its pharmacy and therapeutics committee to the purchaser.
Section 15-1601 – Definitions
(a) In this subtitle the following words have the meanings indicated. (b) “Agent” means a pharmacy, a pharmacist, a mail order pharmacy, or a nonresident pharmacy acting on behalf or at the direction of a pharmacy benefits manager. (c) “Beneficiary” means an individual who receives prescription drug coverage or benefits from a purchaser. (d) (1) “Carrier” means the State Employee […]
Section 15-1604 – Registration
(a) A pharmacy benefits manager shall register with the Commissioner as a pharmacy benefits manager before providing pharmacy benefits management services in the State to purchasers. (b) An applicant for registration shall: (1) file with the Commissioner an application on the form that the Commissioner provides; and (2) pay to the Commissioner a registration fee set by the Commissioner. […]
Section 15-1605 – Expiration; Renewal
(a) A pharmacy benefits manager registration expires on the second September 30 after its effective date unless it is renewed as provided under this section. (b) A pharmacy benefits manager may renew its registration for an additional 2–year term, if the pharmacy benefits manager: (1) otherwise is entitled to be registered; (2) files with the Commissioner a renewal application […]
Section 15-1606 – Agreements With Unregistered Pharmacy Benefits Managers Prohibited
A carrier may not enter into an agreement with a pharmacy benefits manager that has not registered with the Commissioner.
Section 15-1607 – Denials, Suspensions, Revocations, and Refusals to Renew
(a) Subject to the applicable hearing provisions of Title 2 of this article, the Commissioner may deny a registration to a pharmacy benefits manager applicant or refuse to renew, suspend, or revoke the registration of a pharmacy benefits manager if the pharmacy benefits manager, or an officer, director, or employee of the pharmacy benefits manager: (1) makes […]