Common use of Drug Coverage Clause in Contracts

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, 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:: 2 For CHIP, coverage of treatment services is limited to the Package C benefit package coverage limitations. EXHIBIT 1