Common use of Pharmacy Coverage Clause in Contracts

Pharmacy Coverage. PIHPs must carve out all SSA §1927 covered outpatient drugs to fee-for- service (covered outpatient drugs include drugs dispensed in a pharmacy, administered in a doctor’s office, outpatient hospital or clinic; drugs reimbursed at bundled rate are not considered outpatient drugs).

Pharmacy Coverage. a. Pharmacy Coverage PIHPs must carve out all SSA §1927 covered outpatient drugs to fee-for- service (covered outpatient drugs include drugs dispensed in a pharmacy, administered in a doctor’s office, outpatient hospital or clinic; drugs reimbursed at bundled rate are not considered outpatient drugs).