Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.49 - Pharmacy Services Administrative Organizations
Section 31.10.49.05 - Complaint Process

Universal Citation: MD Code Reg 31.10.49.05

Current through Register Vol. 51, No. 26, December 27, 2024

A. Prior to filing a complaint with the Commissioner, a contracted pharmacy or its designee shall exhaust the internal appeal process established by the PSAO.

B. A complaint is properly completed and may be filed if a contracted pharmacy or designee for the pharmacy:

(1) Completes all applicable portions of the Commissioner's complaint form; and

(2) Provides a copy of the relevant contract or the provisions that are related to the internal dispute, including but not limited to any applicable remittance and copy of any appeal decision.

C. Notification of the complaint to the PSAO.

(1) Upon receipt of a completed complaint form, the Commissioner shall provide a copy to the PSAO.

(2) Within 15 working days of receiving the Commissioner's notice, the PSAO shall provide the Commissioner with:
(a) A complete, unredacted copy of the applicable portion of the pharmacy services administrative contract relating to the complaint filed with the Commissioner, including any other contract applicable to the complaint; and

(b) Any other information the Commissioner may require for the purposes of determining a PSAO's compliance with:
(i) The Insurance Article, Annotated Code of Maryland;

(ii) This chapter; or

(iii) The applicable terms of the applicable pharmacy services administrative contract, PBM contract, or applicable purchaser's contract.

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