(1) "Maximum allowable cost" means the maximum amount that a pharmacy benefits manager pays toward the cost of a prescription drug.

(2) "Nationally available" means available to all pharmacies in this State for purchase, without limitation, from regional or national wholesalers and not obsolete or temporarily available.

(3) "Therapeutically equivalent drug substitute" means a prescription drug identified as therapeutically or pharmaceutically equivalent to another prescription drug as evidenced by an "A" code in the most recent version of the United States Food and Drug Administration's "Approved Drug Products with Therapeutic Equivalence Evaluations," also known as "the Orange Book," or an equivalent rating from a successor publication.

(1) By January 1st, the basis of the methods and the sources used to establish the maximum allowable costs used by the pharmacy benefits manager;

(2) Promptly, by written notification, any change made to a maximum allowable cost; and

(3) At least once every 7 days, the maximum allowable costs used by the pharmacy benefits manager.

(1) By January 1st, the basis of the methods and the sources used to establish the maximum allowable costs used by the pharmacy benefits manager;

(2) As soon as practicable, any change made to a maximum allowable cost;

(3) The maximum allowable costs for prescription drugs dispensed at a retail pharmacy if a similar maximum allowable cost list is not used for prescription drugs dispensed by mail, not later than 21 business days after these costs are set; and

(4) Whether the pharmacy benefits manager bills the carrier for a prescription drug an amount consistent with the maximum allowable cost for that drug used for reimbursing a pharmacy and, if the pharmacy benefits manager does not bill and reimburse consistent amounts, the difference between the amount billed and the amount reimbursed.

(1) The prescription drug does not meet the requirements of paragraph B; and

(2) The maximum allowable cost is below the pharmacy's acquisition cost.

(1) If the appeal is upheld, the pharmacy benefits manager shall make the appropriate adjustment in the maximum allowable cost, permit the challenging pharmacy or pharmacist to reverse and rebill the claim in question retroactive to the date of the initial claim adjudication and make the adjustment for each similarly situated pharmacy in the State that is within the network within 5 business days; or

(2) If the appeal is denied, the pharmacy benefits manager shall provide the challenging pharmacy or pharmacist the national drug code from national or regional wholesalers operating in the State of a comparable prescription drug that may be purchased at or below the maximum allowable cost.