Md. Code Regs. 31.10.49.05

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

Section 31.10.49.05 - Complaint Process

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.

Md. Code Regs. 31.10.49.05

Regulation .05 adopted effective 49:26 Md. R. 1081, eff. 12/26/2022