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2021 Maryland Statutes
Insurance
Title 15 - Health Insurance
Subtitle 16 - Pharmacy Benefits Managers
Part V - Contracts With Pharmacies and Pharmacists; Audits
Section 15-1628.3 - Fee or Performance-Based Reimbursement Related to Claim Adjudication
Universal Citation: MD. Insurance Code Ann. § 15-1628.3 (2021)
(a) A pharmacy benefits manager or a purchaser may not directly or indirectly charge a contracted pharmacy, or hold a contracted pharmacy responsible for, a fee or performance–based reimbursement related to the adjudication of a claim or an incentive program.
(b) A pharmacy benefits manager or purchaser may not make or allow any reduction in payment for pharmacy services by a pharmacy benefits manager or purchaser or directly or indirectly reduce a payment for a pharmacy service under a reconciliation process to an effective rate of reimbursement, including generic effective rates, brand effective rates, direct and indirect remuneration fees, or any other reduction or aggregate reduction of payments.
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