1. A. A PBM, whether its contract is directly with a pharmacy or indirectly with a pharmacy through a PSAO or group purchasing organization, shall disclose to a contracted pharmacy at the time of entering into a contract with a pharmacy and at least 30 working days before any contract change for a contracted pharmacy:

   1. (1) The applicable terms, conditions, and reimbursement rates, including:

      1. (a) The sources; and
      2. (b) The terms of the compensation program;
   2. (2) The process and procedures for verifying pharmacy benefits and beneficiary eligibility;
   3. (3) The dispute resolution, internal appeal process under Regulation .04 of this chapter, and audit appeals process; and
   4. (4) The process and procedures for verifying the prescription drugs included on the formularies used by the PBM.

2. B. A PBM, whether its contract is directly with a pharmacy or indirectly with a pharmacy through a PSAO or group purchasing organization, shall:

   1. (1) Update its pricing information at least every 7 days;
   2. (2) Establish a reasonable process by which a contracted pharmacy has access to the current and applicable MAC lists and price list in an electronic format as updated in accordance with the requirements of this section; and
   3. (3) Immediately after a pricing information update occurs pursuant to this regulation, use the updated pricing information in calculating the payments made to all contracted pharmacies.
3. C. A claim paid on behalf of a carrier to a contracted pharmacy under a participating pharmacy contract is subject to the requirements of Insurance Article, §§15-1005, 15-1008, 15-1009, and 15-1631, Annotated Code of Maryland.

Authority: Insurance Article, §§15-1601, 15-1604, 15-1605, 15-1607, 15-1609, 15-1628, 15-1628.1, and 15-1642, Annotated Code of Maryland

Effective date: Effective March 23, 2020 (47:6 Md. R. 343)

Regulation .02B amended effective February 7, 2022 (49:3 Md. R. 141)

Regulation .03 amended effective February 7, 2022 (49:3 Md. R. 141)