Non-Participating Pharmacy Sample Clauses

Non-Participating Pharmacy you must pay for the prescription in full and then submit a claim form for reimbursement. Blue Shield will reimburse you as shown on the Summary of Benefits, based on the price you paid for the Drugs. See the Claims section under Your payment information for more information. Obtaining outpatient prescription Drugs from the mail service pharmacy You have an option to receive prescription Drugs from the mail service pharmacy when you take maintenance Drugs for an ongoing condition. This allows you to receive up to a 90-day supply of the Drug, which may save you money. You may enroll in this program online, by phone, or by mail. Once enrolled, please allow up to 14 days to receive the Drug. If your Physician or Health Care Provider submits a prescription for less than a 90-day supply, the mail service pharmacy will only dispense the amount prescribed. Specialty Drugs are not available from the mail service pharmacy. You must pay the applicable mail service prescription Drug Copayment or Coinsurance for each prescription Drug. Visit xxxxxxxxxxxx.xxx or use the Blue Shield mobile app for additional information about how to get prescription Drugs from the mail service pharmacy.
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Non-Participating Pharmacy. A Pharmacy with which CHPW does not have a contract, including contracted access to any network to which the Pharmacy belongs. Non-Participating Pharmacies may not be able to or may choose not to submit Claims electronically. Plan (also called this plan): The benefits, terms and limitations set forth in the contract between us and you, of which this Agreement is a part.
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Non-Participating Pharmacy. A Network Specialty Pharmacy offers 24-hour clinical ser- vices, coordination of care with Physicians, and reporting of certain clinical events associated with select Drugs to the FDA. To select a Network Specialty Pharmacy, you may go to xxxx://xxx.xxxxxxxxxxxx.xxx or call Customer Service. Go to xxxx://xxx.xxxxxxxxxxxx.xxx for a complete list of Specialty Drugs. Most Specialty Drugs require prior autho- rization for Medical Necessity by Blue Shield, as described in the Prior Authorization/Exception Request Process/Step Therapy section. Prior Authorization/Exception Request Process/Step Therapy Some Drugs and Drug quantities require prior approval for Medical Necessity before they are eligible for coverage un- der the Outpatient Prescription Drug Benefit. This process is called prior authorization. The following Drugs require prior authorization:  Some Formulary, compound Drugs, and most Specialty Drugs require prior authorization.  Drugs exceeding the maximum allowable quantity based on Medical Necessity and appropriateness of ther- apy.  Brand contraceptives may require prior authorization to be covered without a Copayment or Coinsurance. Blue Shield covers compounded medication(s) when:  The compounded medication(s) include at least one Drug,  There are no FDA-approved, commercially available, medically appropriate alternative,  The compounded medication is self-administered, and  Medical literature supports its use for the diagnosis. You must pay the Tier 3 Copayment or Coinsurance for cov- ered compound Drugs. You, your Physician or Health Care Provider may request prior authorization for the Drugs listed above by submitting supporting information to Blue Shield. Once Blue Shield re- ceives all required supporting information, we will provide prior authorization approval or denial, based upon Medical Necessity, within 72 hours in routine circumstances or 24 hours in exigent circumstances. Exigent circumstances exist when a Member has a health condition that may seriously jeopardize the Member’s life, health, or ability to regain maximum function or when a Member is undergoing a cur- rent course of treatment using a Non-Formulary Drug. To request coverage for a Non-Formulary Drug, you, your representative or Health Care Provider may submit an excep- tion request to Blue Shield. Once all required supporting in- formation is received, Blue Shield will approve or deny the exception request, based upon Medical Necessity, within 72 hours in routine ...
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Non-Participating Pharmacy. Any Pharmacy other than a Participating Pharmacy which regularly sells Prescription Drugs.
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Non-Participating Pharmacy. A Network Specialty Pharmacy offers 24-hour clinical ser- vices, coordination of care with Physicians, and reporting of certain clinical events associated with select Drugs to the FDA. To select a Network Specialty Pharmacy, you may go to xxxx://xxx.xxxxxxxxxxxx.xxx or call Customer Service. Go to xxxx://xxx.xxxxxxxxxxxx.xxx for a complete list of Specialty Drugs. Most Specialty Drugs require prior autho- rization for Medical Necessity by Blue Shield, as described in the Prior Authorization/Exception Request Process/Step Therapy section. Limitation on Quantity of Drugs that May Be Obtained Per Prescription or Refill
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Non-Participating Pharmacy. A Network Specialty Pharmacy offers 24-hour clinical services, coordination of care with Physicians, and reporting of certain clinical events associated with select Drugs to the FDA. To select a Network Specialty Pharmacy, the Member may go to xxxx://xxx.xxxxxxxxxxxx.xxx or call Shield Concierge. Go to xxxx://xxx.xxxxxxxxxxxx.xxx for a complete list of Specialty Drugs. Most Specialty Drugs require prior authorization for Medical Necessity by Blue Shield, as described in the Prior Authorization/Exception Request Process section. Prior Authorization/ Exception Request/ Step Therapy Process Some Drugs and Drug quantities require prior approval for Medical Necessity before they are eligible to be covered by the Outpatient Prescription Drug Benefit. This process is called prior authorization. The following Drugs require prior authorization:
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Non-Participating Pharmacy. If you have a Prescription Order filled at a Non- Participating Pharmacy, you must pay the Pharmacy the full amount of its bill and submit to Blue Cross and Blue Shield a Claim form and itemized receipt veri- fying that the prescription was filled. Blue Cross and Blue Shield will reimburse you for Covered Drugs equal to: S the Coinsurance Amount or Copayment Amount indicated on your Schedule Page, S less any deductible, S less any pricing differences that may apply to the Covered Drug you receive. Mail- Order Pharmacy The mail- order Pharmacy provides delivery of Covered Drugs directly to your home address. If you and your covered dependents elect to use the mail- order service, refer to your Schedule Page for applicable payment levels. All items that are covered under the mail- order Pharmacy are the same items that are covered under retail Pharmacy and are subject to the same limitations and exclusions. Items covered through a specialty Phar- macy will not be covered through the mail- order Pharmacy. NOTE: Prescription drugs and other items may not be mailed outside the United States. The mail- order Pharmacy has been selected to fill and deliver maintenance (long- term) medications. In order to receive maximum benefits you must obtain these maintenance medications through mail order. Some drugs may not be available through the mail- order Pharmacy. If you have any questions about this mail- order service, need assistance in determining the amount of your payment, or need to obtain the mail- order prescription form, you may access the website at xxx.xxxxxx.xxx or contact Customer Service at the toll- free number on your Identification Card. Mail the completed form, your Prescription Order(s) and pay- ment to the address indicated on the form. If you send an incorrect payment amount for the Covered Drug dispensed, you will: (a) receive a credit if the payment is too much; or (b) be billed for the appropriate amount if it is not enough.
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Non-Participating Pharmacy. Any registered, licensed pharmacy with whom Our pharmacy benefit administrator or We do not have a contract.
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Non-Participating Pharmacy. If you choose to visit a Non-Network pharmacy and the pharmacy is willing to accept reimbursement at the same rates as a participating pharmacy, they can submit a request for reimbursement to Us. Contact us at 0-000-000-0000 if you and your pharmacy wish to pursue this option. Prior Authorization Some medications, despite being prescribed by your Healthcare Provider, require an additional review by a Clinician before you can fill the prescription. This process is called Prior Authorization. A Clinician performs a Prior Authorization review to ensure the prescribed drug is safe, effective, and appropriate for your specific treatment plan. A list of the medications which require a Prior Authorization and the required forms are available on our website at xxx.xxxxxxx.xxx or by contacting member services at 1-855- 672-2789. We will review all Prior Authorization requests and make a decision to approve or deny coverage for the requested medication based on established clinical criteria. A decision will be made within the time limits specified by State or NCQA Regulations. If you or Your Health Care Provider do not agree with the decision made by Us, you have the ability to contest the decision (see ""When you disagree'). If your health care provider does not obtain a Prior Authorization, the pharmacy will be alerted when they are attempting to submit a claim to Us and you will not be able to receive your medication. Step Therapy Certain medications are subject to step therapy requirements. This means that in order to receive benefits for such medications you are required to try a different medication first unless you satisfy the plan’s exception criteria. You may identify whether a particular medication is subject to step therapy requirements at xxx.xxxxxxx.xxx or by contacting member services at 0-000-000-0000. A step therapy exception will be granted if Your prescribing Provider submits justification and supporting clinical documentation, if needed, is completed and determined to support such provider's statement that: • The required prescription drug is contraindicated or will cause an adverse reaction or physical or mental harm to the patient; • The required prescription drug is expected to be ineffective based on Your known clinical condition and the known characteristics of the prescription drug regimen; • You have tried the required prescription drug or another prescription drug in the same pharmacological class or with the same mechanism of action as th...
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Related to Non-Participating Pharmacy

  • Non-Participating This Contract is classified as a non-participating contract. It does not participate in our profits or surplus, and therefore no dividends are payable.

  • Participating Providers To find out if a Provider is a Participating Provider: • Check Our Provider directory, available at Your request; • Call the number on Your ID card; or • Visit our website at xxx.xxxxxx.xxx. The Provider directory will give You the following information about Our Participating Providers: • Name, address, and telephone number; • Specialty; • Board certification (if applicable); • Languages spoken; and • Whether the Participating Provider is accepting new patients.

  • Contractor Key Personnel ‌ The Contractor shall assign a Corporate OASIS Program Manager (COPM) and Corporate OASIS Contract Manager (COCM) as Contractor Key Personnel to represent the Contractor as primary points-of-contact to resolve issues, perform administrative duties, and other functions that may arise relating to OASIS and task orders solicited and awarded under XXXXX. Additional Key Personnel requirements may be designated by the OCO at the task order level. There is no minimum qualification requirements established for Contractor Key Personnel. Additionally, Contractor Key Personnel do not have to be full-time positions; however, the Contractor Key Personnel are expected to be fully proficient in the performance of their duties. The Contractor shall ensure that the OASIS CO has current point-of-contact information for both the COPM and COCM. In the event of a change to Contractor Key Personnel, the Contractor shall notify the OASIS CO and provide all Point of Contact information for the new Key Personnel within 5 calendar days of the change. All costs associated with Contractor Key Personnel duties shall be handled in accordance with the Contractor’s standard accounting practices; however, no costs for Contractor Key Personnel may be billed to the OASIS Program Office. Failure of Contractor Key Personnel to effectively and efficiently perform their duties will be construed as conduct detrimental to contract performance and may result in activation of Dormant Status and/or Off-Ramping (See Sections H.16. and H.17.).

  • Participating Consumers All Participating Consumers as of the Effective Date will continue to be enrolled in the Program under the terms of this ESA unless they opt-out. Within one (1) day after the Effective Date, the Town shall provide to Competitive Supplier a list of Participating Consumers as of the Effective Date, as well as such Participating Consumers’ service and billing addresses, and any other information necessary for Competitive Supplier to commence All-Requirements Power Supply to such Participating Consumers as of the Service Commencement Date.

  • DESIGNATED PERSONNEL The Contractor will provide the Designated Personnel listed below for the duration of the Contract at no charge to the State. Information regarding the Designated Personnel is set forth in Appendix D – Contractor and Reseller Information. Contractor must notify OGS within five (5) business days if any of the Designated Personnel change, and provide an interim contact person until the position is filled. Contractor may submit a Designated Personnel change by submission electronically via e-mail of a revised Appendix D – Contractor and Reseller Information to the OGS Contract Administrator. The Designated Personnel must have the authority to act on behalf of the Contractor: Account Manager The Account Manager is responsible for the overall relationship with the State during the course of the Contract and shall act as the central point of contact. Contract Administrator The Contract Administrator is responsible for the updating and management of the Contract on a timely basis. Sales Manager The Sales Manager is responsible for the overall relationship with the Authorized Users for matters relating to RFQs.

  • Non-Parties If a Tax Indemnitee is not a party to this Agreement, Owner may require the Tax Indemnitee to agree in writing, in a form reasonably acceptable to Owner, to the terms of this Section 8.3 and Section 15.8 prior to making any payment to such Tax Indemnitee under this Section 8.3.

  • Subrecipient’s Project Manager and Key Personnel Subrecipient shall appoint a Project Manager to direct the Subrecipient’s efforts in fulfilling Subrecipient’s obligations under this Contract. This Project Manager shall be subject to approval by the County and shall not be changed without the written consent of the County’s Project Manager, which consent shall not be unreasonably withheld. The Subrecipient’s Project Manager, in consultation and agreement with County, shall be assigned to this project for the duration of the Contract and shall diligently pursue all work and services to meet the project time lines. The County’s Project Manager shall have the right to require the removal and replacement of the Subrecipient’s Project Manager from providing services to the County under this Contract. The County’s Project Manager shall notify the Subrecipient in writing of such action. The Subrecipient shall accomplish the removal within five (5) business days after written notice by the County’s Project Manager. The County’s Project Manager shall review and approve the appointment of the replacement for the Subrecipient’s Project Manager. The County is not required to provide any additional information, reason or rationale in the event it The County is not required to provide any additional information, reason or rationale in the event it requires the removal of Subrecipient’s Project Manager from providing further services under the Contract.

  • Supplier Diversity Seller shall comply with Xxxxx’s Supplier Diversity Program in accordance with Appendix V.

  • Subrecipients when submitting financial reporting packages to DEO for audits done in accordance with 2 CFR 200, Subpart F - Audit Requirements, or Chapters 10.550 (local governmental entities) and 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, should indicate the date that the reporting package was delivered to Subrecipient in correspondence accompanying the reporting package.

  • Third Party Vendors Nothing herein shall impose any duty upon DST in connection with or make DST liable for the actions or omissions to act of the following types of unaffiliated third parties: (a) courier and mail services including but not limited to Airborne Services, Federal Express, UPS and the U.S. Mails, (b) telecommunications companies including but not limited to AT&T, Sprint, MCI and other delivery, telecommunications and other such companies not under the party’s reasonable control, and (c) third parties not under the party’s reasonable control or subcontract relationship providing services to the financial industry generally, such as, by way of example and not limitation, the National Securities Clearing Corporation (processing and settlement services), Fund custodian banks (custody and fund accounting services) and administrators (blue sky and Fund administration services), and national database providers such as Choice Point, Acxiom, TransUnion or Lexis/Nexis and any replacements thereof or similar entities, provided, if DST selected such company, DST shall have exercised due care in selecting the same. Such third party vendors shall not be deemed, and are not, subcontractors for purposes of this Agreement.

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