Drug Coverage. Prescription drugs and certain over-the-counter drugs are benefits under the Hoosier Care Connect program to be covered by the Contractor. Members are responsible for a copayment for covered drugs in the amount outlined in Section 12.2. The Contractor shall support FSSA in promptly responding to public and legislative inquiries involving the design and management of the Contractor’s pharmacy benefit. If the Contractor elects to subcontract with a pharmacy benefit manager (PBM), the Contractor must ensure compliance with all subcontracting requirements outlined in Section 2.3, including but not limited to conducting regular audits and monitoring of the subcontractor’s data and performance, as well as requiring their PBM to conduct regular audits of their pharmacy provider networks.
Drug Coverage. Prescription drugs, certain over-the-counter drugs, pharmacy supplements, and other specified products are benefits under the Hoosier Healthwise program to be covered by the Contractor. Per 21 § CFR 203.3, prescription drug means any drug (including any biological product, except for blood and blood components intended for transfusion or biological products that are also medical devices) required by Federal law (including Federal regulation) to be dispensed only by a prescription, including finished dosage forms and bulk drug substances subject to section 503(b) of the Social Security Act. The Contractor agrees to abide by 42 CFR 438.3(s), the Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) and P.L. 115-271, “SUPPORT” Act. The Contractor shall follow the statewide unified preferred drug list (SUPDL) for the pharmacy benefit. The SUPDL will consist of the fee-for-service (FFS) PDL. Adoption of the SUPDL shall include alignment of prior authorization (PA), forms, and step edit and utilization edit criteria for drugs and drug classes that are part of the SUPDL. The Contractor will discontinue and not seek commercial discounts and commercial rebate agreements with pharmaceutical manufacturers for IHCP member pharmacy benefits. The Contractor may only set a Maximum Allowable Cost (MAC) rate on a multiple source drug available from at least two manufacturers. The MAC rate may not be applied when the brand product is preferred over available generics on the SUPDL. The Contractor shall develop an escalation process for specified unique review processes and requests submitted by State or federal legislators, the Governor, the Secretary, news media and/or of a controversial nature. The Contractor shall assure that all claims (including emergency claims) from a non-IHCP pharmacy will reject. In addition, all claims (except emergency claims) from a non-IHCP prescribing provider will reject. The Contractor shall provide for ninety (90) days of continuity of care for all pre-existing drug regimens for all new members. This will allow time for the PBM to work with the prescribing provider to negotiate future drug regimens. The Contractor shall assure proper and complete PBM agent training. The Contractor shall always ensure that, during the term of this contract, its pharmacy benefit fully complies with applicable provisions of law including IC 12-15-35, IC 12-15-35.5 and IC 27-1-24.5. If the Contractor enters into a contract or agreement with a Pharmacy Benefit M...
Drug Coverage. The Company will increase the life time maximum from ten thousand ($10,000.00) dollars to one hundred twenty thousand ($120,000.00) dollars for hospital, extended health and drug benefits for full-time employees.
Drug Coverage. Prescription drugs, certain over-the-counter drugs, and pharmacy supplements are benefits under the Hoosier Care Connect program to be covered by the Contractor. The Contractor agrees to abide by 42 CFR 437-438.3(s), the Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) and P.L. 115-271, “SUPPORT” Act. If directed as such by FSSA, the Contractor shall utilize a common or unified PDL/PA criteria, including discontinuation of commercial discount and commercial rebates agreements with pharmaceutical manufacturers for IHCP member pharmacy benefits, or consolidation of the pharmacy benefit under the FFS program. If the Contractor enters into a contract or agreement with a Pharmacy Benefit Manager (PBM) for the provision and administration of pharmacy services, the contract or agreement shall be developed as a pass-through pricing model as defined below:
Drug Coverage. Prescription drugs, certain over-the-counter drugs, and pharmacy supplements are benefits under the Hoosier Healthwise program to be covered by the Contractor. The Contractor agrees to abide by 42 CFR 437-438.3(s), the Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) and P.L. 115-271, “SUPPORT” Act. If directed as such by FSSA, the Contractor shall utilize common or unified PDL/PA criteria, including discontinuation of commercial discount and commercial rebate agreements with pharmaceutical manufacturers for IHCP member pharmacy benefits, or consolidation of the pharmacy benefit under the FFS program. The Contractor shall assure proper and complete PBM agent training. The Contractor shall always ensure that, during the term of this contract, its pharmacy benefit fully complies with applicable provisions of law including IC 12-15-35, IC 12-15-35.5 and IC 27-1-24.5. If the Contractor enters into a contract or agreement with a Pharmacy Benefit Manager (PBM) for the provision and administration of pharmacy services, the contract or agreement shall be developed as a pass-through pricing model as defined below:
Drug Coverage. Prescription drugs, certain over-the-counter drugs, pharmacy supplements, and other specified products are benefits under the HIP program to be covered by the Contractor. Per 21 § CFR 203.3, prescription drug means any drug (including any biological product, except for blood and blood components intended for transfusion or biological products that are also medical devices) required by Federal law (including Federal regulation) to be dispensed only by a prescription, including finished dosage forms and bulk drug substances subject to section 503(b) of the Social Security Act. The Contractor agrees to abide by 42 CFR 438.3(s), the Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) and P.L. 115-271, “SUPPORT” Act. The Contractor shall follow the statewide unified preferred drug list (SUPDL) for the pharmacy benefit. The SUPDL will consist of the fee-for-service (FFS) PDL. Adoption of the SUPDL shall include alignment of prior authorization (PA), forms, and step edit and utilization edit criteria for drugs and drug classes that are part of the SUPDL. The Contractor will discontinue and not seek commercial discounts and commercial rebate agreements with pharmaceutical EXHIBIT 1.A SCOPE OF WORK manufacturers for IHCP member pharmacy benefits. The Contractor may only set a Maximum Allowable Cost (MAC) rate on a multiple source drug available from at least two manufacturers. The MAC rate may not be applied when the brand product is preferred over available generics on the SUPDL. The Contractor shall assure proper and complete PBM agent training.
Drug Coverage. Prescription drugs, certain over-the-counter drugs, pharmacy supplements, and other specified products are benefits under the Hoosier Healthwise program to be covered by the Contractor. Per 21 § CFR 203.3, prescription drug means any drug (including any biological product, except for blood and blood components intended for transfusion or biological products that are also medical devices) required by Federal law (including Federal regulation) to be dispensed only by a prescription, including finished dosage forms and bulk drug substances subject to section 503(b) of the Social Security Act. The Contractor agrees to abide by 42 CFR 438.3(s), the Medicaid and CHIP Managed Care Final Rule (CMS-2390-F) and P.L. 115-271, “SUPPORT” Act. The Contractor shall follow the statewide unified preferred drug list (SUPDL) for the pharmacy benefit. The SUPDL will consist of the fee-for-service (FFS) PDL. Adoption of the SUPDL shall include alignment of prior authorization (PA), forms, and step edit and utilization edit criteria for drugs and drug classes that are part of the SUPDL. The Contractor will discontinue and not seek commercial discounts and commercial rebate agreements with pharmaceutical manufacturers for IHCP member pharmacy benefits.
Drug Coverage. The City will provide for active employees, their spouse and their dependent children a self-funded prescription drug plan. This drug plan will provide prescription drugs at no cost through a designated pharmacy. The drug plan will also reimburse 90% of prescription costs at non-designated pharmacies. Unless a - I prescription states "Dispense as Written" or the prescribing physician requires a brand name, the drug plan will pay for only the generic equivalent. The plan will cover only reasonable and customary charges.
Drug Coverage. The Contractor shall:
Drug Coverage. Per prescription drug deductible is included and equal to $5.00. 80% Reimbursement on eligible drugs to a maximum benefit of $2,000 per annum per employee. Benefit formulary is Medavie Blue Cross standard, plus diabetic supplies. It includes prescription drug items approved by Medavie Blue Cross and certain over-the-counter items which are considered life-saving in nature and are approved by Medavie Blue Cross. The following diabetic supplies are also included: charges for needles, syringes, swabs, test tapes, and lancets as prescribed by a physician. Certain prescription-requiring drugs on the eligible drug benefit list may be subject to quantity maximums. Eligible drug expenses include medically necessary items which, by law, can only be obtained with a prescription of a physician or dentist, limited to a three month supply, which are authorized as benefits by Medavie Blue Cross, and which are dispensed by a licensed pharmacist. Medavie Blue Cross will reimburse only for the lowest priced interchangeable drug when prescribed by a physician and dispensed by a pharmacist, unless the physician indicates no substitution.
