PARRIS N. GLENDENING, Governor

Ch. 573

(ii) Establish a family unit structure; and

(iii) Beginning July 1, 1985, increase annually at the time social security
benefits are increased, rounded to the next highest even $50 level, the income level within
which an individual is eligible for benefits under the Maryland Pharmacy Assistance
Program by the larger of:

1.       The percentage by which benefits under Title II of the Social
Security Act (42 U.S.C. 401-433) are increased by the federal government due to
cost-of-living changes as that percentage is reported in the Federal Register pursuant to
42 U.S.C. 415(i)(2)(d) but not to exceed 8 percent; or

2.       The dollar amount by which the medical assistance income
schedules are increased by the State.

(b)     (1) Reimbursement under the Maryland Pharmacy Assistance Program shall
be limited to maintenance drugs, anti-infectives, and AZT as specified in regulations to
be issued by the Secretary after consultation with the Maryland Pharmacists Association.
For any drug on the Program's interchangeable drug list, the Program shall reimburse
providers in an amount not more than it would reimburse for the drug's generic
equivalent, unless the individual's physician states, in his or her own handwriting, on the
face of the prescription, that a specific brand is "medically necessary" for the particular
patient.

(2) The reimbursement shall be up to the amount paid for the same items or
services under the pharmacy program of the Maryland Medical Assistance Program and
shall be subject to a copayment of not more than $5.00 for each covered item or service.

(c)     (1) Unless the change is made by an emergency regulation, the Maryland
Pharmacy Assistance Program shall notify all pharmacies under contract with the
Program in writing of changes in the Pharmaceutical Benefit Program rules or
requirements at least 30 days before the change is effective.

(2)     Changes that require 30 days' advance written notice under paragraph
(1) of this subsection are:

(i) Exclusion of coverage for classes of drugs as specified by contract;

(ii) Changes in prior or preauthorization procedures; and

(iii) Selection of new prescription claims processors.

(3)     If the Maryland Pharmacy Assistance Program fails to provide advance
notice as required under paragraph (1) of this subsection, it shall honor and pay in full
any claim under the Program rules or requirements that existed before the change for 30
days after the postmarked date of the notice.

(d)     (1) The Secretary shall adopt rules and regulations that authorize the
denial, restriction, or termination of eligibility for recipients who have abused benefits
under the Maryland Pharmacy Assistance Program.

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