Code of Maryland Regulations
Title 31 - MARYLAND INSURANCE ADMINISTRATION
Subtitle 10 - HEALTH INSURANCE-GENERAL
Chapter 31.10.50 - Filing of PSAO Contracts and Amendments
Section 31.10.50.04 - Noncompliant Contract Terms

(1) Violates Title 15, Subtitle 16 or Subtitle 20 of the Insurance Article, Annotated Code of Maryland or any applicable statutory provisions, including but not limited to Insurance Article, §§ 15-1611, 15-1628, 15-1628.1, 15-1628.2, 15-1628.3, 15-1629, 15-1631, 15-1633, 15-1634-151639, 15-2011, 15-2013(c), 15-2015, and 15-2016, Annotated Code of Maryland;

(2) Includes a definition of "multisource generic drug" that is inconsistent with COMAR 31.46, or "generic" or "brand name drug" that is inconsistent with Health Occupations Article, § 12-504, Annotated Code of Maryland;

(3) Allows the PBM to reimburse a covered drug in an amount that differs, including zero, based on the identity of the wholesale distributor used by a contracting pharmacy for acquisition of the covered drug;

(4) Except for instances of error or fraud, allows a PBM or PSAO to re-classify, re-categorize, or re-characterize an adjudicated claim;

(5) In any way prohibits or restricts a pharmacist or pharmacy from filing a complaint with the Commissioner; and

(6) Fails to include the internal appeal provisions in the contract.