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Statutes Text

Article - Insurance




§15–1628.

    (a)    At the time of entering into a contract with a pharmacy or a pharmacist, and at least 30 working days before any contract change, a pharmacy benefits manager shall disclose to the pharmacy or pharmacist:

        (1)    the applicable terms, conditions, and reimbursement rates;

        (2)    the process and procedures for verifying pharmacy benefits and beneficiary eligibility;

        (3)    the dispute resolution and audit appeals process; and

        (4)    the process and procedures for verifying the prescription drugs included on the formularies used by the pharmacy benefits manager.

    (b)    (1)    A contract or an amendment to a contract between a pharmacy benefits manager, a pharmacy services administration organization, or a group purchasing organization and a pharmacy may not become effective unless:

            (i)    at least 30 days before the contract or amendment is to become effective, the pharmacy benefits manager, pharmacy services administration organization, or group purchasing organization files the contract or amendment with the Commissioner in the form required by the Commissioner; and

            (ii)    the Commissioner does not disapprove the filing within 30 days after the contract or amendment is filed.

        (2)    The Commissioner shall adopt regulations to establish the circumstances under which the Commissioner may disapprove a contract.