Pharmacy Reporting Clause Samples

Pharmacy Reporting. The Contractor shall provide additional reporting specific to the pharmacy program, including, but not limited to: Pharmacy help desk performance; Prior authorization performance; Prior Authorization request turnaround time; Number of claims submitted as a 72-hour emergency supply; Denials (name of drug, number of requests, number of denials); Pharmacy network access; Grievance and appeals and Medication therapy management initiatives. a) Abandonment rates must be five percent or less. Calls are considered abandoned if the caller hangs up after 30 seconds and does not talk with a Customer Service Representative. b) Service levels must be at least 80% for incoming calls. The service level is calculated by the following formula: Service Level = ((T – (A + B)/T)) * 100, where: T = all calls that enter the queue A = calls that are answered after 30 seconds B = calls that are abandoned after 30 seconds c) 90% of telephone inquiries, excluding billing inquiries, must be responded to during the initial call.