Participating Pharmacies Sample Clauses

Participating Pharmacies. The PBM’s Participating Pharmacies are available to Enrollees who use medically necessary drugs Participating mail service pharmacies have toll free access to registered pharmacists to answer your questions. Participating specialty pharmacies have dedicated patient care coordinators to help You manage Your condition and offer toll-free twenty-four hour access to nurses and registered Pharmacists. You may obtain a list of the Participating Pharmacies, and Covered Drugs, by calling the Customer Service telephone number on the back of Your ID card, or review the lists on Our website at Covered Prescription Drug Benefits include the following.  Prescription Legend Drugs.  Injectable insulin and syringes used for administration of insulin.  Oral contraceptive Drugs, injectable contraceptive drugs and patches are Covered when obtained through an eligible Pharmacy.  If certain supplies, equipment or appliances are not obtained by Mail Service or from a Participating Pharmacy then they are Covered as Medical Supplies, Equipment and Appliances instead of under Prescription Drug benefits and may be subject to applicable DME Copays or Coinsurance.  Injectables.  Medical food that is Medically Necessary and prescribed by a Physician for the treatment of an inherited metabolic disease. Medical food means a formula that is intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and formulated to be consumed or administered enterally under the direction of a Physician. Non-Covered Prescription Drug Benefits  Prescription Drugs dispensed by any Mail Service program other than the PBM’s Mail Service, unless prohibited by law.  Drugs, devices and products, or Prescription Legend Drugs with over the counter equivalents and any Drugs, devices or products that are therapeutically comparable to an over the counter Drug, device, or product.  Off label use, except as otherwise prohibited by law or as approved by Us or the PBM.  Drugs in quantities exceeding the quantity prescribed, or for any refill dispensed later than one year after the date of the original Prescription Order.  Drugs not approved by the FDA.  Charges for the administration of any Drug.  Drugs consumed at the time and place where dispensed or where the Prescription Order is issued, including but not limited to samples provided by a Physician. This does not apply to Drugs used in conjunction with ...
Participating Pharmacies. ESI will maintain a network(s) of Participating Pharmacies as identified in Exhibit A, and will make available an updated list of Participating Pharmacies on-line. ESI maintains multiple networks and subnetworks, and periodically consolidates networks or migrates clients to other networks and subnetworks. If, due to an access concern, Sponsor requests that ESI attempt to add a particular retail pharmacy to the network of Participating Pharmacies serving Sponsor and its Members hereunder, ESI will make commercially reasonable efforts to add any such pharmacy to the Participating Pharmacy network for Sponsor, provided that such pharmacy meets ESI’s network participation requirements and agrees to ESI’s standard terms and conditions. If any such pharmacy meets ESI’s network participation requirements and agrees to ESI’s standard terms and conditions except for ESI’s standard network rates (i.e., the particular pharmacy will only agree to higher than standard reimbursement rates), and Sponsor nevertheless requests that ESI add such pharmacy, the rate charged to Sponsor for Prescription Drug Claims processed through such pharmacy (assuming ESI agrees to contract with such pharmacy) will be the net ingredient cost plus the dispensing fee paid by ESI to such Participating Pharmacy (plus applicable sales or excise tax or other governmental surcharge, if any). All such Prescription Drug Claims will be excluded from the pricing guarantees set forth in Exhibit A.
Participating Pharmacies. CastiaRx contracts, or arranges for contracts, with retail pharmacies to dispense prescription drugs to members. The rates paid by CastiaRx to these pharmacies differ from one network to another and among pharmacies. CastiaRx generally contracts with clients at a uniform rate that applies to all pharmacies in the selected network or may have a pass-through rate arrangement. Please review the PBM Agreement to determine the terms and conditions applicable to payments for retail pharmacy claims. Where the rate paid by a client exceeds the rate negotiated with a particular pharmacy, CastiaRx will realize a positive margin on the applicable prescription. The reverse may also be true, resulting in a negative margin. In addition, CastiaRx retains the benefit of the use of funds when CastiaRx receives payment from a client before paying the pharmacies. Pharmacy Dispensing and Distribution – One or more CastiaRx affiliates own and operate licensed pharmacies, including the CastiaRx Specialty Pharmacy and CastiaRx Mail Pharmacy. CastiaRx purchases prescription drug inventories, either directly from manufacturers or from drug wholesalers, for dispensing to patients or for distribution to Physician offices. Purchase discounts off of acquisition cost of these products are made available by manufacturers in the form of both up-front and retrospective discounts, and may include fees for certain services provided to manufacturers (e.g., Adverse Event reporting), and patients served through the CastiaRx Specialty Pharmacy. Such discounts are not considered part of the rebates paid to CastiaRx by manufacturers in connection with our rebate program. While rebates are directly attributable to the utilization of pharmaceutical products by individuals who receive benefits from clients for whom we provide PBM services, product acquisition price discounts are based on a pharmacy’s inventory needs and, in the case of specialty pharmacies, the performance of related patient care service obligations. The purchase discounts obtained by these facilities are not based on any client’s benefit design. When CastiaRx dispenses or distributes a product from its inventory or that of its retail pharmacy network, the purchase price paid for the dispensed product, including applicable dispensing fees, may be greater or less than the pharmacy’s acquisition cost for the product net of purchase discounts. In some circumstances, there may be a difference between what a client pays for a dispensed p...
Participating Pharmacies. Members who fill prescriptions at a non-participating pharmacy are responsible for payment at the time the prescription is filled. Members must submit claims to Anthem Blue Cross and Blue Shield for reimbursement, and payment will be sent to the member, Members who use non-participating pharmacies will pay 20% of the in-network allowance, plus the difference between Anthem Blue Cross and Blue Shield's payment and the pharmacist's actual charge. Limits and Exclusions Benefits are limited to no more than a 30-day supply for covered drugs purchased at a retail pharmacy, and no more than a 100-day supply for covered drugs purchased by mail service. All prescriptions are subject to the quantity limitations imposed by state and federal statutes. Benefits for prescription birth control and Sexual Dysfunction medications are optional for groups such as yours. Check with your benefits administrator to find out whether or not you have such benefits, This is not a legal contract. It is only a general description of the Managed Rx, 3 Tier version. Please consult the Evidence of Coverage or prescription drug rider for a complete description of benefits and exclusions applicable to your coverage. Anthem. •V Lumerros Lumenos HSA Plan Summary The Lameness NSA plat is designed to empower you to take control are heath), as well as the dollars you spend on your health care, This pith gives you the Xxxxx-Xxxx would receive from a typical health plan, plus health care defiers to spend your way. Xxx you'll have access to personalized services and online tools to help you reach your health potential. First- Use your HSA to pay for covered services: Health Savings Account With the Lumenos Health Savings Account (RSA), you can contribute pre-tax dollars to your HSA account. Others may also contribute dollars to your account. You can use these dollars to help meet your annual deductible responsibility. Unused dollars can be saved or invested and accumulate through retirement Contributions to Your HSA For 2017, contributions can be made to your NSA up to the following: $3,400 individual coverage $6,750 tank coverage Nate: These xxxxx apply to all combined contributions from any source indudng HSA dollarsfrom Incentives. Earn More Money for Your Account What's special about your Lumenos HSA plan is that you may earn additional funds for your health account through the Healthy Rewards incentive program. To receive funds earned through the Heathy Rewards program, you must have an open ...
Participating Pharmacies. Sponsor acknowledges and agrees that neither PBM, nor its shareholders, directors, officers or employees have any liability whatsoever to Sponsor or Members for the acts or omissions of any Participating Pharmacy (including, but not necessarily limited to, the acts or omissions of any Participating Pharmacy’s employees or agents) in connection with such Participating Pharmacy’s provision of services to Sponsor or Members, including, but not necessarily limited to, any of the following: (i) any actual or alleged malpractice, negligence or misconduct of any Participating Pharmacy; or (ii) the sale, compounding, dispensing, failure to sell, manufacture or use of any drug dispensed to a Member under this Agreement.
Participating Pharmacies. The term
Participating Pharmacies. Client shall not be eligible for rebates with respect to prescriptions under the Rebate Program if Participating Pharmacies are obligated or provided a financial incentive to follow or comply with a drug formulary other than the Formulary in connection with providing services for Participants of CarePlus.

Related to Participating Pharmacies

  • Pilot Programs The Employer may develop voluntary pilot programs to test the acceptability of various risk management programs. Incentives for participation in such programs may include limited short-term improvements to the benefits outlined in this Article. Implementation of such pilot programs is subject to the review and approval of the Joint Labor-Management Committee on Health Plans.

  • Wellness A. To support the statewide goal for a healthy and productive workforce, employees are encouraged to participate in a Well-Being Assessment survey. Employees will be granted work time and may use a state computer to complete the survey.

  • Primary Care Clinic Employees and each of their covered dependents must individually elect a primary care clinic within the network of providers offered by the plan administrator chosen by the employee. Employees and their dependents may elect to change clinics within their clinic’s Benefit Level as often as the plan administrator permits and as outlined above.

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.