Pharmacy Access. Effective March 1, 2012, the MCO must meet the following minimum requirements. The MCO must ensure that all Members have access to at least one (1) Network Pharmacy within 15 miles of the Member's residence, and access to at least one (1) pharmacy with 24-hour coverage within 75 miles of the Member's residence. MCOs may request exceptions to this requirement on a case-by-case basis. Effective September 1, 2012, HHSC will apply additional benchmark performance standards. For purposes of this requirement only, the terms urban, suburban, and rural counties have the following meaning: Urban - Counties that have been designated as metropolitan by the Office of Management and Budget (OMB), and that contain the most populated city within a metropolitan area, also known as Metropolitan Statistical Area. HHSC Strategic Decision Support (SDS) classifies these counties as Metro Central City counties. A county meets the definition of metropolitan if it has a central city, or pair of twin cities in it, with a minimum population of 50,000. Suburban - Counties that have been designated as metropolitan by the OMB, and that are adjacent (share a boundary) to a Metro Central City county. The SDS classifies these counties as Metro Suburban counties. Rural - Non-metropolitan counties of the state, regardless of whether they are adjacent or non-adjacent to a metropolitan county. For counties included in the Medicaid Rural Service Area, the following standard applies to STAR effective September 1, 2012: • In urban counties, at least 75 percent of Members must have access to a Network Pharmacy within 2 miles of the Member's residence; • In suburban counties, at least 55 percent of Members must have access to a Network Pharmacy within 5 miles of the Member's residence; • In rural counties, at least 90 percent of Members must have access to a Network Pharmacy within 15 miles of the Member's residence; and • In urban, suburban, and rural counties, at least 90 percent of Members must have access to a 24-hour pharmacy within 75 miles of the Member's residence. For all other counties and Programs, the following standard applies effective September 1, 2012: • In urban counties, at least 80 percent of Members must have access to a Network Pharmacy within 2 miles of the Member's residence; • In suburban counties, at least 75 percent of Members must have access to a Network Pharmacy within 5 miles of the Member's residence; • In rural counties, at least 90 percent of Members must have acc...
Pharmacy Access. Contractor shall ensure an Enrollee has access to at least one (1) pharmacy within a fifteen (15)–mile radius of or fifteen (15)–minute drive from the Enrollee’s residence. If an Enrollee lives in a Rural Area, the Enrollee shall have access to at least one (1) pharmacy within a sixty (60)–mile radius of or sixty (60)–minute drive from his or her residence.
Pharmacy Access. For purposes of this section, "prescription" shall include authorization for legend and over-the-counter drugs covered by Medicaid policy.
Pharmacy Access. At a minimum, the MCO must ensure that all Members have access to at least one (1) Network Pharmacy within 15 miles of the Member’s residence, and access to at least one (1) pharmacy with 24-hour coverage within 75 miles of the Member’s residence. MCOs may request exceptions to this requirement on a case-by-case basis. All other Covered Services, except for services provided in the Member’s residence: At a minimum, the MCO must ensure that all Members have access to at least one (1) Network Provider for each of the remaining Covered Services described in Attachments B-2, “STAR Covered Services,” B-2.1 “CHIP Covered Services,” and B-2.2, “STAR+PLUS Covered Services,” within 75 miles of the Member’s residence. This access requirement includes, but is not limited to, specialists, specialty Hospitals, psychiatric Hospitals, diagnostic and therapeutic services, and single or limited service health care physicians or Providers, as applicable to the MCO Program. The MCO is not precluded from making arrangements with physicians or providers outside the MCO’s Service Area for Members to receive a higher level of skill or specialty than the level available within the Service Area, including but not limited to, treatment of cancer, xxxxx, and cardiac diseases. HHSC may consider exceptions to the above access-related requirements when an MCO has established, through utilization data provided to HHSC, that a normal pattern for securing Health Care Services within an area does not meet these standards, or when an MCO is providing care of a higher skill level or specialty than the level which is available within the Service Area.
Pharmacy Access a. The MCO shall be responsible for payment for pharmacy services and all associated charges, regardless of a Member's diagnosis. The only exception is that the Partnership shall be responsible for methadone costs that are part of the bundled reimbursement for methadone maintenance and ambulatory detox providers. Prescribing behavioral health providers participating in the Partnership will follow the applicable pharmacy program requirements, including the formulary, of the MCO. These providers will provide the MCO with any clinical information needed to support requests for authorization or the preparation of summaries for administrative hearings. The MCO shall promptly inform the Department of any changes to its pharmacy program requirements.
Pharmacy Access. 8.2.1 The Customer shall not access or use the Pharmacy Access Solution for the purposes of operating a distance selling chemist operation, being a pharmacy business which provides pharmaceutical services from distance selling premises (as defined in the NHS (Pharmaceutical Services) Regulations 2012).
