Common use of Coverage Exclusions Clause in Contracts

Coverage Exclusions. In accordance with Section 1927 of the Social Security Act, 42 U.S.C.A. 1396r-8, the Contractor must exclude coverage for any drug marketed by a drug company (or labeler) who does not participate in the MA FFS Medicaid Drug Rebate Program. Therefore, the Contractor is not permitted to provide coverage for any drug product, brand name or generic, legend or non-legend, sold or distributed by a company that did not sign an agreement with the federal government to provide rebates to the Medicaid agency. In addition, the Contractor must allow access to all drug products covered by the MA FFS Program. This includes brand name and generic products, as well as all outpatient legend drugs, sold or distributed by companies that participate in the rebate program for all medically accepted indications, as described in Section 1927(k)(6) of the Social Security Act, 42 U.S.C.A. 1396r-8(k)(6). The Contractor must include coverage for non-legend drugs as required under formulary guidelines and covered by the MA FFS Program. This includes any use which is approved under the Federal Food, Drug, and Cosmetic Act, 21 U.S.C.A. 301 et seq. or, whose use is supported by the American Hospital Formulary Service - Drug Information, American Medical Association Drug Evaluations, United States Pharmacopoeia - Drug Information, and DRUGDEX.

Coverage Exclusions. In accordance with Section 1927 of the Social Security Act, 42 U.S.C.A. 1396r-8, the Contractor must exclude coverage for any drug marketed by a drug company (or labeler) who does not participate in the MA FFS Medicaid Drug Rebate Program. Therefore, the Contractor is not permitted to provide coverage for any drug product, brand name or generic, legend or non-legend, sold or distributed by a company that did not sign an agreement with the federal government to provide rebates to the Medicaid agency. In addition, the Contractor must allow access to all drug products covered by the MA FFS Program. This includes brand name and generic products, as well as all outpatient legend drugs, sold or distributed by companies that participate in the rebate program for all medically accepted indications, as described in Section 1927(k)(6) of the Social Security Act, 42 U.S.C.A. 1396r-8(k)(6). The Contractor must include coverage for non-legend drugs as required under formulary guidelines and covered by the MA FFS Program. This includes any use which is approved under the Federal Food, Drug, and Cosmetic Act, 21 U.S.C.A. 301 et seq. or, whose use is supported by the American Hospital Formulary Service - Drug Information, American Medical Association Drug Evaluations, United States Pharmacopoeia - -- Drug Information, and DRUGDEX.and