Common use of Pharmacy Benefit Clause in Contracts

Pharmacy Benefit. a. In providing the Medicaid pharmacy benefit to their members, MCPs must cover the same drugs covered by the FFS program, in accordance with OAC rule 5160-26-03(A) and (B). However, pursuant to ORC Section 5167.12, MCPs may, subject to ODM approval, implement strategies for the management of drug utilization. (See appendix K.2.f.i). b. MCPs must participate in semi-annual meetings to obtain prior ODM approval of changes to the MCP list of drugs requiring prior authorization. Unless otherwise authorized by ODM, the semi-annual meeting process will assure that the combined list of drugs requiring prior authorization for each MCP results in a combined percentage agreement that is no less than seventy-five percent.