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2000 LAWS OF MARYLAND
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Ch. 544
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B. The dollar amount by which the medical assistance income
schedules are increased by the State.
(b) (1) (i) 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.
(ii) 1. 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. If an appropriate generic drug is not generally available,
the Department may waive the reimbursement requirement under
sub-subparagraph 1 of this subparagraph.
(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] $6.00 for each
covered item or service.
(c) (1) Except as provided under paragraph (4) of this subsection and 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.
(4) Notwithstanding any other provision of law, the notice requirements
of this subsection do not apply to the addition of new generic drugs authorized under
§ 12-504 of the Health Occupations Article.
(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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- 2876 -
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