§ 15-124. Maryland Pharmacy Assistance Program

   (a) Eligibility for Program. -- The Department shall maintain a Maryland Pharmacy Assistance Program for low income individuals not eligible for Medicare whose:

   (1) Assets are not more than the level established by the federal Centers for Medicare and Medicaid Services under the Qualified Medicare Beneficiary Program; and

   (2) Gross annual income does not exceed 116% of the federal poverty guidelines for an individual or 100% of the federal poverty guidelines for a family of two or more.

(b) Reimbursement. --

   (1) (i) Reimbursement under the Maryland Pharmacy Assistance Program may 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 subsubparagraph 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:

      (i) $ 2.50 for a generic drug or a brand name drug on a preferred drug list established by the Department; and

      (ii) $ 7.50 for a brand name drug not on a preferred drug list established by the Department.

(c) Notice to pharmacies of change in pharmaceutical benefits. --

   (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) Rules, regulations or conditions regarding eligibility or participation. --

   (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.

   (2) As a condition of participation, the Department may require Maryland Pharmacy Assistance Program participants to apply for eligibility in the Maryland Medical Assistance Program within 60 days of notification to do so by the Department.

   (3) The rules and regulations shall require that the recipient be given notice and an opportunity for a hearing before eligibility may be denied, restricted, or terminated under this subsection.

(e) Information on other programs. -- The Secretary shall develop a program, in consultation with appropriate agencies, that will provide information to ineligible Maryland Pharmacy Assistance Program applicants regarding other programs that they may be eligible for including the Maryland Medbank Program established under § 15-124.2 of this subtitle and the Senior Prescription Drug Assistance Program established under Title 14, Subtitle 5 of the Insurance Article.

HISTORY: An. Code 1957, art. 43, § 42M; 1982, ch. 21, § 2; ch. 495; 1985, ch. 176; 1986, ch. 28; 1987, ch. 323; 1989, ch. 440; 1990, ch. 44; 1991, ch. 401; 1992, ch. 521; 1993, ch. 98; 1995, chs. 573, 592; 1996, ch. 102, § 2; 1997, ch. 14, § 20; ch. 173; 1998, ch. 21, § 1; 2000, ch. 61, § 7; ch. 544; 2001, ch. 134, § 1; ch. 135, § 1; 2002, ch. 464; 2003, chs. 270, 344; 2005, ch. 281, § 2; ch. 282, § 2; 2009, ch. 60, § 5.