§ 15-1636
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/md/insurance/15-1636A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§15–1636.
(a)A pharmacy benefits manager or its agent shall cancel and reverse a therapeutic interchange on written or verbal instructions from a prescriber, the beneficiary, or the beneficiary’s representative.
(b)If a therapeutic interchange is reversed, the pharmacy benefits manager or its agent shall:
(1)obtain a prescription for and dispense the originally prescribed prescription drug; and
(2)charge the beneficiary no more than one copayment.
(c)If the therapeutic interchange occurred through a mail order pharmacy and a beneficiary will exhaust an existing supply of the originally prescribed prescription drug before a replacement shipment will arrive to the beneficiary, the pharmacy benefits manager or its agent shall arrange for dispensing of an appropriate quantity of replacement prescription drugs at a local community pharmacy at no additional cost to the beneficiary.
(d)A pharmacy benefits manager or its agent may not be required to cancel and reverse a therapeutic interchange if a beneficiary is unwilling to pay a higher copayment or coinsurance associated with the originally prescribed prescription drug.