Covered Outpatient Drugs Sample Clauses

Covered Outpatient Drugs. The Contractor shall provide coverage of covered outpatient drugs and prescribed drugs as defined in Section 1927 of the Social Security Act, that meets the standard of coverage imposed by Section 1927 as if such standards applied directly to Contractor. If the Contractor’s formulary does not provide coverage of a drug that is otherwise covered by Kentucky Medicaid for individuals in the FFS program, the Contractor must ensure access and coverage to the off-formulary covered outpatient or prescribed drug in the same manner as Kentucky Medicaid FFS and in accordance with the prior authorization requirements of Section 1927.

Covered Outpatient Drugs. Contractor shall provide coverage of covered outpatient drugs as defined in Section 1927(k)(2) of the Social Security Act. Non-preferred drugs meet the definition of a covered outpatient drug and cannot be excluded from coverage. In the event a covered outpatient drug is not covered through Contractor’s pharmacy benefit, it must be covered through Contractor’s medical benefit. In the event Contractor does not include a covered outpatient drug onits pharmacy formulary, Contractor must have a process for Enrolleesto access that drug through a prior authorization process, inaccordance with 42 CFR §438.3(s)(1).