Pharmacy Benefits a. Pharmacy benefits are available to all State of Ohio employees and their dependents enrolled in a health plan.
Pharmacy Benefits. The Summary of Pharmacy Benefits only applies to prescription drugs purchased at a retail, mail order, or specialty, pharmacy.
Pharmacy Benefits. $2,500 per Calendar Day per occurrence
Pharmacy Benefits. USNH shall provide Bargaining Unit Members and their dependents Pharmacy Benefits consistent with the benefits approved and outlined in USNH Benefit offerings.
Pharmacy Benefits. Prescription drugs are a benefit under the HIP program to be covered by the Contractor. The Contractor shall support FSSA in promptly responding to public and legislative inquiries involving the design and management of the Contractor’s pharmacy benefit. If the Contractor elects to subcontract with a PBM, the Contractor shall ensure compliance with all subcontracting requirements outlined in Section 2.7, including but not limited to EXHIBIT 2.H HEALTHY INDIANA PLAN SCOPE OF WORK conducting regular audits and monitoring of the subcontractor’s data and performance, as well as requiring their PBM to conduct regular audits of their pharmacy provider networks. The Contractor shall not be responsible for member pharmacy claims incurred prior to the effective date of this contract. The Contractor shall, at the direction of the Secretary, implement specified fee-for- service PDL and/or prior authorization, if unified PDL is not implemented. The Contractor shall develop an escalation process for specified unique review processes and requests submitted by state or federal legislators, the Governor, the Secretary, news media and/or of a controversial nature. The Contractor shall assure that all claims (including emergency claims) from a non-IHCP pharmacy will reject. In addition, all claims (except emergency claims) from a non-IHCP prescribing provider will reject. The Contractor shall provide for ninety (90) days of continuity of care for all pre- existing drug regimens for all new members. This will allow time for the PBM to work with the prescribing provider to negotiate future drug regimens. The Contractor shall assure proper and complete PBM agent training. The Contractor shall ensure that at all times during the term of this contract its pharmacy benefit fully complies with applicable provisions of IC 12-15-35 and IC 12-15-35.5.
Pharmacy Benefits. Prescription drugs are a benefit under the HIP program to be covered by the Contractor. The Contractor shall support FSSA in promptly responding to public and legislative inquiries involving the design and management of the Contractor’s pharmacy benefit. If the Contractor elects to subcontract with a PBM, the Contractor shall ensure compliance with all subcontracting requirements outlined in Section 2.7, including but not limited to conducting regular audits and monitoring of the subcontractor’s data and performance, as well as requiring their PBM to conduct regular audits of their pharmacy provider networks. The Contractor shall not be responsible for member pharmacy claims incurred prior to the effective date of this contract. The Contractor shall, at the direction of the Secretary, implement specified fee-for- service PDL and/or prior authorization, if unified PDL is not implemented. The Contractor shall develop an escalation process for specified unique review processes and requests submitted by state or federal legislators, the Governor, the Secretary, news media and/or of a controversial nature. The Contractor shall assure that all claims (including emergency claims) from a non-IHCP pharmacy will reject. In addition, all claims (except emergency claims) from a non-IHCP prescribing provider will reject. The Contractor shall provide for ninety (90) days of continuity of care for all pre- existing drug regimens for all new members. This will allow time for the PBM to work with the prescribing provider to negotiate future drug regimens. The Contractor shall assure proper and complete PBM agent training. The Contractor shall ensure that at all times during the term of this contract its pharmacy benefit fully complies with applicable provisions of IC 12-15-35 and IC 12-15-35.5.
Pharmacy Benefits. This section describes coverage for prescription drugs and diabetic equipment/supplies purchased at a retail, specialty, or mail order pharmacy. This section is a part of the Subscriber Agreement and not separate from it. Coverage is provided per the terms, conditions, exclusions, and limitations of this Subscriber Agreement. Required Preauthorization Prescription drugs for which preauthorization is required are marked with the symbol (+) in the Summary of Pharmacy Benefits. Preauthorization is required for certain brand name prescription drugs and certain specialty Prescription Drugs. For details on how to obtain prescription drug preauthorization for a prescription drug, see Section 1.6 and Section 3.28 - subsection “How to Obtain Prescription Drug Preauthorization. This prescription drug plan formulary has a four-tiered copayment structure. The copayment for a prescription drug will vary by tier. For more information about our formulary, and to see the tier placement of a particular prescription drug, visit our website or call our Customer Service Department. The Summary of Pharmacy Benefits table, below, indicates the tier structure and the amount that you are responsible to pay. The tier placement of our formulary is subject to change. Formulary Listing Our formulary lists generic, preferred brand name, and non-preferred brand name prescription drugs and specialty prescription drugs covered under this agreement. To obtain a copy of the most current formulary listing, visit our Web site at XXXXXX.xxx. or you may call our Customer Service Department at (000) 000-0000 or 0-000-000-0000 or Voice TDD 711. Medication Synchronization (less than a 30 day supply) In accordance with Rhode Island General Law §27-18-50.1, a prorated copayment may be applied for covered prescription drugs, used to treat chronic long-term conditions, when prescribed for less than a (30) thirty day supply and dispensed by a network pharmacy if: • the prescribing physician and pharmacist determine it is in the best interest of the member; and • the member requests or agrees to less than a thirty (30) day supply. In addition, in order to qualify for medication synchronization, the covered prescription drug must: • be a maintenance drug used for the management and treatment of a chronic long-term care condition; • not be a controlled substance; • meet all utilization management requirements specific to the drug; • be of a formulation able to be split over the required shortened supply ...
Pharmacy Benefits. $5,000 per standard authorization request $7,500 per expedited authorization request
Pharmacy Benefits. PROVIDER shall comply with ASES’ terms and conditions for pharmacy benefit management as set forth in ASES law and regulations which is incorporated herein by reference. PROVIDER shall require a countersignature from the enrollees PCP in order to fill a prescription written by a Provider who is not in the PPN. PROVIDER shall not require a PCP Countersignature on prescriptions written by a Provider within the PPN. PROVIDER is prohibited to distribute to GHP enrollees prescription drugs and medications acquired directly by PROVIDER or PMG, or through contracts with third parties, and ignoring the use of pharmacy providers contracted by the PBM’s for this purpose. PROVIDER shall use the FMC as a first option at the moment of prescribing and shall observe the exceptions process when filling a prescription for a drug not on the FMC. PROVIDER shall not outright deny medication because it is not included on ASES’s FMC or LME. A medication not on the FMC or LME may be provided through the exceptions process established by First Medical.
Pharmacy Benefits. Contractor will provide prescription drug coverage through ___________________. Online services are available through ___________ at www.______________.com. .
