Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 3
Subtitle 11 - MATERNAL AND CHILD HEALTH
Chapter 10.11.03 - Children's Medical Services Program
Section 10.11.03.18 - Billing Procedures for Pharmacy Services

Universal Citation: MD Code Reg 10.11.03.18

Current through Register Vol. 51, No. 19, September 20, 2024

A. A pharmacy provider shall comply with all procedures listed in Regulation .13 of this chapter.

B. A pharmacy provider shall:

(1) Upon request, produce records to verify any charge to the CMS Program; and

(2) Charge the CMS Program the usual and customary charge to the general public for similar prescriptions.

C. Determination of allowable cost for multiple source drugs designated by the Centers for Medicare and Medicaid Services of the Department of Health and Human Services or for each drug listed in the formulary allowable cost shall be the lowest of the maximum allowable cost.

D. Payment for covered services to a pharmacy shall be made as follows:

(1) Payment for formulary drug preparation shall be the:
(a)-(b) (text unchanged)

(2) Payment for over-the-counter drugs is not covered except in extenuating circumstances at the discretion of the CMS Program

(3) Payment for medical supplies and durable equipment shall be the:
(a) Most cost-efficient; or

(b) Maximum limit established by the Department based upon the lowest price at which the product is generally available throughout the State.

E. In order to determine whether the current professional fee is appropriate, the Department shall periodically conduct surveys to determine the actual costs involved in filling a prescription in the State.

Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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