Common use of Mail Order Pharmacy Clause in Contracts

Mail Order Pharmacy. 4.13.1 The PBM shall maintain, and provide WellPoint’s Plan access to the mail service pharmacy(s) network to provide Covered Prescriptions to Covered Individuals through the United States Postal Service or private shipping enterprises. 4.13.2 Nothing in the Agreement or this Part D Exhibit shall prohibit the PBM from utilizing or contracting with third-party mail service pharmacies to provide Covered Prescriptions to Covered Individuals. The rates applicable to the Pharmacies participating in the Mail Order Pharmacy network shall be consistent with the rates set forth in Exhibit A. Collectively, the PBM’s owned or affiliated mail order Pharmacies and other third-party mail order Pharmacies shall be referred to as “Mail Order Pharmacy.” 4.13.3 Mail Order Pharmacy shall receive prescriptions from Covered Individuals via the U.S. mail or commercial carrier at an address specified by each Mail Order Pharmacy from time to time. Subject to reasonable processing parameters, Mail Order Pharmacy or its designee shall dispense drugs covered by the Plan in accordance with such prescriptions, and mail the Covered Prescriptions to Covered Individuals at addresses designated by such Covered Individuals, so long as such addresses are located in the United States or Puerto Rico. 4.13.4 Mail Order Pharmacy and its designees shall dispense Covered Prescriptions according to applicable state and federal law and in accordance with standards of care prevalent in the mail service pharmacy industry. Mail Order Pharmacy shall have no obligation to fill any prescription for Covered Prescriptions, which is not accompanied by an appropriately completed order form and the payment of any applicable Co-payment, Co-insurance or Deductible. The PBM shall implement applicable measures to help ensure Mail Order Pharmacies implement appropriate monitoring and quality control measures in an effort to promote accurate and timely dispensing and communication of patient specific information. The PBM shall ensure that Mail Order Pharmacies provide a professional pharmacist staff to evaluate the appropriateness of prescriptions to the extent required by standard pharmacy practice and laws. 4.13.5 Mail Order Pharmacy shall provide to Covered Individuals toll-free telephone access to pharmacists and service representatives. 4.13.6 Claims submitted by Covered Individuals through Mail Order Pharmacy or its designee shall be processed in a manner similar to the manner in which retail Claims are processed under the Agreement and this Part D Exhibit. 4.13.7 Nothing herein shall be construed to prohibit or otherwise limit the ability of any pharmacist employed by a Mail Order Pharmacy to exercise his or her professional judgment, including the refusal to fill a prescription. Further, nothing herein shall be construed to require the PBM’s Mail Order Pharmacy or any other Mail Order Pharmacy to stock all federal legend drugs.

Mail Order Pharmacy. 4.13.1 The PBM shall maintain, and provide WellPoint’s Plan access to the mail service pharmacy(s) network to provide Covered Prescriptions to Covered Individuals through the United States Postal Service or private shipping enterprises. 4.13.2 Nothing in the Agreement or this Part D Exhibit shall prohibit the PBM from utilizing or contracting with third-party mail service pharmacies to provide Covered Prescriptions to Covered Individuals. The rates applicable to the Pharmacies participating in the Mail Order Pharmacy network shall be consistent with the rates set forth in Exhibit A. Collectively, the PBM’s owned or affiliated mail order Pharmacies and other third-party mail order Pharmacies shall be referred to as “Mail Order Pharmacy.” 4.13.3 Mail Order Pharmacy shall receive prescriptions from Covered Individuals via the U.S. mail or commercial carrier at an address specified by each Mail Order Pharmacy from time to time. Subject to reasonable processing parameters, Mail Order Pharmacy or its designee shall dispense drugs covered by the Plan in accordance with such prescriptions, and mail the Covered Prescriptions to Covered Individuals at addresses designated by such Covered Individuals, so long as such addresses are located in the United States or Puerto Rico. 4.13.4 Mail Order Pharmacy and its designees shall dispense Covered Prescriptions according to applicable state and federal law and in accordance with standards of care prevalent in the mail service pharmacy industry. Mail Order Pharmacy shall have no obligation to fill any prescription for Covered Prescriptions, which is not accompanied by an appropriately completed order form and the payment of any applicable Co-payment, Co-insurance or Deductible. The PBM shall implement [*] Redacted text. Confidential treatment requested; omitted text filed separately with the Securities and Exchange Commission. 112 applicable measures to help ensure Mail Order Pharmacies implement appropriate monitoring and quality control measures in an effort to promote accurate and timely dispensing and communication of patient specific information. The PBM shall ensure that Mail Order Pharmacies provide a professional pharmacist staff to evaluate the appropriateness of prescriptions to the extent required by standard pharmacy practice and laws. 4.13.5 Mail Order Pharmacy shall provide to Covered Individuals toll-free telephone access to pharmacists and service representatives. 4.13.6 Claims submitted by Covered Individuals through Mail Order Pharmacy or its designee shall be processed in a manner similar to the manner in which retail Claims are processed under the Agreement and this Part D Exhibit. 4.13.7 Nothing herein shall be construed to prohibit or otherwise limit the ability of any pharmacist employed by a Mail Order Pharmacy to exercise his or her professional judgment, including the refusal to fill a prescription. Further, nothing herein shall be construed to require the PBM’s Mail Order Pharmacy or any other Mail Order Pharmacy to stock all federal legend drugs.