Md. Code Regs. 17.04.15.05

Current through Register Vol. 51, No. 24, December 2, 2024

Section 17.04.15.05 - Services Available to Purchasing Pool Members

A. A purchasing pool member shall benefit from participation in the Maryland Rx Program as follows:

(1) Setting the fully insured equivalent premiums (including employee and employer portion as applicable) for its own self-funded plan, without reference to the employer and employee contributions set by the State for the State's prescription benefits plan; and

(2) Receiving, in exchange for the negotiated administrative fee, the following services in connection with its own pharmacy or prescription benefits plan:

(a) Account management services;

(b) Claims payment, processing and tracking services;

(c) Reporting;

(d) Enrollment tracking; and

(e) Invoicing.

B. The drug ingredient cost and pricing terms, maximum dispensing fees, and minimum rebate guarantees that are associated with the total enrollment in the Maryland Rx Program shall be used to calculate the costs payable by and rebates issued to each purchasing pool member in connection with its prescription benefits plan.

Md. Code Regs. 17.04.15.05