Pharmacy Services Lock-In Program Sample Clauses

The Pharmacy Services Lock-In Program clause establishes a system where certain individuals are required to obtain their prescription medications from a designated pharmacy or group of pharmacies. This typically applies to patients who have demonstrated patterns of overutilization or misuse of prescription drugs, such as controlled substances, and may involve coordination with healthcare providers and insurers to monitor compliance. The core function of this clause is to help prevent prescription drug abuse and fraud, ensuring patient safety and controlling healthcare costs by limiting opportunities for inappropriate medication access.
Pharmacy Services Lock-In Program. DMS will manage a Pharmacy Services Lock-In Program to coordinate the provision of health care services for PIHP members who abuse or misuse pharmacy benefits by seeking duplicate or medically unnecessary services, for restricted medications. Abuse or misuse is defined under Recipient Duties in DHS 104.02, Wisconsin Administrative Code. Restricted medications are most controlled substances and tramadol. PIHP members enrolled in the Pharmacy Services Lock-In Program will be locked into one pharmacy where prescriptions for restricted medications must be filled and one primary prescriber who will prescribe restricted medications. PIHP members will remain enrolled in the Pharmacy Services Lock-In Program for two years. At the end of the two-year enrollment period, DMS or the PIHP will assess if the member should continue enrollment in the Pharmacy Services Lock-In Program. Policy on the Pharmacy Services Lock-In Program can be found in the BadgerCare Plus and Medicaid Pharmacy Provider Handbook.
View SourceView Similar (6)
Pharmacy Services Lock-In Program. DHCAA will manage a Pharmacy Services Lock-In Program to coordinate the provision of health care services for HMO members who abuse or misuse pharmacy benefits by seeking duplicate or medically unnecessary services, for restricted medications. Abuse or misuse is defined under Recipient Duties in DHS 104.02, Wisconsin Administrative Code. Restricted medications are most controlled substances, and tramadol. HMO members enrolled in the Pharmacy Services Lock-In Program will be locked into one pharmacy where prescriptions for restricted medications must be filled and one primary prescriber who will prescribe restricted medications. HMO members will remain enrolled in the Pharmacy Services Lock-In Program for two years. At the end of the two-year enrollment period, DHCAA or the HMO will assess if the member should continue enrollment in the Pharmacy Services Lock-In Program. Policy on the Pharmacy Services Lock-In Program can be found in the BadgerCare Plus and Medicaid Pharmacy Provider Handbook.
View SourceView Similar (3)
Pharmacy Services Lock-In Program. DMS will manage a Pharmacy Services Lock-In Program to coordinate the provision of health care services for PIHP members who abuse or misuse pharmacy benefits by seeking duplicate or medically unnecessary services, for restricted medications. Abuse or misuse is defined under Recipient Duties in DHS 104.02, Wisconsin Administrative Code. Restricted medications are most controlled substances. PIHP members enrolled in the Pharmacy Services Lock-In Program will be locked into one pharmacy where prescriptions for restricted medications must be filled and one primary prescriber who will prescribe restricted medications. PIHP members will remain enrolled in the Pharmacy Services Lock-In Program for two years. At the end of the two-year enrollment period, DMS or the PIHP will assess if the member should continue enrollment in the Pharmacy Services Lock-In Program. Policy on the Pharmacy Services Lock-In Program can be found in the BadgerCare Plus and Medicaid Pharmacy Provider Handbook. The Division of Medicaid Services (DMS) or its designated representative must: a) Manage the Pharmacy Services Lock-In Program and communicate directly with the PIHPs regarding their members. b) Monitor prescription drug usage for members enrolled in the Pharmacy Services Lock-In Program. c) Accept select review requests from the PIHP for potential Pharmacy Services Lock-In Program members. Not all select reviews may result in intervention letters or lock-in for the member. d) Accept referrals from the PIHP for the Pharmacy Services Lock-In Program. DMS or its designated representative will proceed with Pharmacy Services lock-in for referred members. e) Request additional information from the PIHP for referrals. The PIHP must provide requested information to DMS or its designated representative. f) Identify the lock-in pharmacy and the PIHP must identify the lock-in primary prescriber for each member. In addition, the PIHP must identify any alternate prescribers for restricted medications, as appropriate. g) Send letters of notification to the lock-in member and PIHP for the lock-in pharmacy. h) Provide an electronic monthly report to the PIHP that identifies any members in the Pharmacy Services Lock-In Program for the specific PIHP. i) Coordinate with the PIHP for the Pharmacy Services Lock- In Program policies and procedures. PIHP Responsibilities a) PIHPs may request select reviews based on prescription drug utilization for potential Pharmacy Services Lock-In Program members. No...
View Source
Pharmacy Services Lock-In Program. A program implemented by the Department to coordinate the provision of health care services for HMO members who abuse or misuse pharmacy benefits by seeking duplicate or medically unnecessary services, for restricted medications. Members enrolled in the program will have one pharmacy provider and one primary prescriber for restricted medications.
View Source
Pharmacy Services Lock-In Program. A program implemented by the Department to coordinate the provision of health care services for PIHP members who abuse or misuse pharmacy benefits by seeking duplicate or medically unnecessary services, for restricted medications. Members enrolled in the program will have one pharmacy provider and one primary prescriber for restricted medications.
View Source

Related to Pharmacy Services Lock-In Program

  • Pharmacy Services The Contractor agrees to comply with the requirements regarding covered pharmacy and over-the- counter (OTC) benefits. The Contractor will comply with the EOHHS Pharmacy Home Program and the Generics First Initiative, including the maintenance of the drug formulary in accordance with the direction of the EOHHS Pharmacy Committee.

  • Program Services a) Personalized Care Practice agrees to provide to Program Member certain enhancements and amenities to professional medical services to be rendered by Personalized Care Practice to Program Member, as further described in Schedule 1 to these Terms. Upon prior written notice to Program Member, Personalized Care Practice may add or modify the Program Services set forth in Schedule 1, as reasonably necessary, and subject to such additional fees and/or terms and conditions as may be reasonably necessary. b) Program Member acknowledges that the Program Services are services that are not covered services under any insurance contract to which Program Member may be a party, including, without limitation, Medicare, and are not reimbursable by Program Member’s insurer, health plan or any governmental entity, including Medicare. Program Member agrees to bear sole financial responsibility for the Member Amenities Fee and agrees not to submit to Program Member’s insurer, health plan or governmental entity any ▇▇▇▇, invoice or claim for payment or reimbursement of such Member Amenities Fee. c) Personalized Care Practice or its designated affiliate will separately charge Program Member or Program Member’s insurer, health plan or governmental entity for medical, clinical, diagnostic or therapeutic services rendered by Personalized Care Practice or its designated affiliate to Program Member, and Program Member may seek payment or reimbursement from Program Member’s insurer or health plan for any such service to the extent covered by Program Member’s insurer, health plan or governmental entity. d) Program Member understands, agrees and covenants that this Agreement is a service contract, and not a contract for insurance.

  • Medical Services Plan 10.1.1 Regular Full-Time and Temporary Full-Time Employees shall be entitled to be covered under the Medical Services Plan commencing the first day of the calendar month following the date of employment. 10.1.2 The City shall pay one hundred percent (100%) of the premiums required by the Plan.

  • Clinical Management for Behavioral Health Services (CMBHS) System 1. request access to CMBHS via the CMBHS Helpline at (▇▇▇) ▇▇▇-▇▇▇▇. 2. use the CMBHS time frames specified by System Agency. 3. use System Agency-specified functionality of the CMBHS in its entirety. 4. submit all bills and reports to System Agency through the CMBHS, unless otherwise instructed.

  • Mastectomy Services Inpatient