Preferred Drug List and Formulary Requirements Sample Clauses

Preferred Drug List and Formulary Requirements. The Contractor shall maintain a preferred drug list (PDL) for the Contractor’s Hoosier Healthwise packages. The Hoosier Healthwise formulary shall support the coverage and non-coverage requirements for legend and non-legend drugs by Indiana Medicaid. More information can be found in 000 XXX 0-00-0, 405 IAC 5-24-4, 405 IAC 5-24-5 and 407 IAC 3-10-1. Prior to implementing a PDL or formulary, the Contractor shall: (i) submit the PDL or formulary to OMPP for submission to the Drug Utilization and Review (DUR) Board; and (ii) receive approval from OMPP in accordance with IC 00-00-00-00. At least thirty-five (35) days before the intended implementation date of the PDL and formulary, the Contractor shall submit its proposed PDL and formulary to OMPP. The OMPP shall submit the PDL and formulary to the Drug Utilization Review (DUR) Board for review and recommendation. The Contractor shall be accessible to the DUR Board to respond to any questions regarding the PDL and formulary. The DUR Board will provide a recommendation regarding approval of the PDL and formulary in accordance with the terms of IC 00-00-00-00. OMPP will approve, disapprove or modify the PDL and/or formulary based on the DUR Board’s recommendation. The Contractor shall comply with the decision within sixty (60) days after receiving notice of the decision. The Contractor shall utilize a Pharmacy and Therapeutics Committee which shall meet regularly to make recommendations for changes to the PDL and/or formulary. In accordance with IC 00-00-00-00, prior to removing one (1) or more drugs from the PDL and/or formulary or otherwise placing new PA criteria on one
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Preferred Drug List and Formulary Requirements. The Contractor shall maintain a preferred drug list (PDL) for the Contractor’s HIP program. The HIP formulary shall support the coverage and non-coverage requirements for legend drugs by Indiana Medicaid, found in 405 IAC 5-24-3. In accordance with CMS-2390-F, the Contractor shall demonstrate prescription drug coverage consistent with the amount, duration, and scope of the fee-for-service program. The Contractor shall engage with the State process to develop universal medically necessary prior authorization criteria for IHCP. The Contractor shall implement the universal IHCP criteria into their program and may not utilize more restrictive criteria. While the underlying drug formulary for the HIP Plus and the HIP Basic plans will be identical, additional pharmacy services will differ between the plans in order to align the benefits with the overall program goals aimed at encouraging member participation in HIP Plus. Therefore, the HIP Basic pharmacy benefit may have more restrictions than the HIP plus benefit, such as limiting prescription supplies to 30 days. Also, prescriptions obtained by a HIP Basic or HIP State Plan Basic member that are not otherwise exempt on the basis of being preventive, family planning, or maternity, are subject to the copayment amounts set forth in Section 4.1.2. Copayments assessed to the HIP Basic or HIP State Plan Basic member at the point of sale may not exceed the total cost of the drug. Similarly, the HIP Plus pharmacy benefit shall provide additional enhanced pharmacy services including the following: (i) ninety (90) day prescription supplies of routine maintenance medications, when requested by the member; (ii) mail order pharmacy benefit; (iii) and no copayment for any filled prescription. These additional pharmacy services shall only be made available to individuals participating in HIP Plus and HIP State Plan Plus benefits. Prior to implementing a PDL or formulary, the Contractor shall: (i) submit the PDL or formulary to OMPP for submission to the Drug Utilization and Review (DUR) Board; and (ii) receive approval from OMPP in accordance with IC 00-00-00-00. At least thirty-five (35) days before the intended implementation date of the PDL and formulary, the Contractor shall submit its proposed PDL and formulary to OMPP. The OMPP shall submit the PDL and formulary to the Drug Utilization Review (DUR) Board for review and recommendation. The Contractor shall be accessible to the DUR Board to respond to any questions regar...
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Preferred Drug List and Formulary Requirements. The Contractor shall maintain a preferred drug list (PDL) for the Contractor’s Hoosier Healthwise packages. The Hoosier Healthwise formulary shall support the coverage and non-coverage requirements for legend and non-legend drugs by Indiana Medicaid. More information can be found in 000 XXX 0-00-0, 405 IAC 5-24-4, 405 IAC 5-24-5 and 407 IAC 3-10-1. Prior to implementing a PDL or formulary, the Contractor shall: (i) submit the PDL or formulary to OMPP for submission to the Drug Utilization and Review (DUR) Board; and
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Preferred Drug List and Formulary Requirements. The Contractor shall maintain a preferred drug list (PDL) for the Contractor’s Hoosier Healthwise packages. The Hoosier Healthwise formulary shall support the coverage and non-coverage requirements for legend and non-legend drugs by Indiana Medicaid. More information can be found in 000 XXX 0-00-0, 405 IAC 5-24-4, 405 IAC 5-24-5 and 407 IAC 3-10-1. In accordance with CMS-2390-F, the Contractor shall demonstrate prescription drug coverage consistent with the amount, duration, and scope of the fee-for-service program. The Contractor shall EXHIBIT 1.E
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Preferred Drug List and Formulary Requirements. The Contractor shall maintain a preferred drug list (PDL) for the Contractor’s HIP program. The HIP formulary shall support the coverage and non-coverage requirements for legend drugs by Indiana Medicaid, found in 405 IAC 5-24- 3. While the underlying drug formulary for the HIP Plus and the HIP Basic plans will be identical, additional pharmacy services will differ between the plans in order to align the benefits with the overall program goals aimed at encouraging member participation in HIP Plus. Therefore, the HIP Basic pharmacy benefit may have more restrictions than the HIP plus benefit, such as limiting prescription supplies to 30 days. Also, prescriptions obtained by a HIP Basic or HIP State Plan Basic member that are not otherwise exempt on the basis of being preventive, family planning, or maternity, are subject to the copayment amounts set forth in Section 4.1.2. Copayments assessed to the HIP Basic or HIP State Plan Basic member at the point of sale may not exceed the total cost of the drug. Similarly, the HIP Plus pharmacy benefit shall provide additional enhanced pharmacy services including the following: (i) ninety (90) day prescription supplies of routine maintenance medications, when requested by the member;
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Related to Preferred Drug List and Formulary Requirements

  • Alcohol and Drug Testing Employee agrees to comply with and submit to any Company program or policy for testing for alcohol abuse or use of drugs and, in the absence of such a program or policy, to submit to such testing as may be required by Company and administered in accordance with applicable law and regulations.

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  • Prescription Drugs The agreement may impose a variety of limits affecting the scope or duration of benefits that are not expressed numerically. An example of these types of treatments limit is preauthorization. Preauthorization is applied to behavioral health services in the same way as medical benefits. The only exception is except where clinically appropriate standards of care may permit a difference. Mental disorders are covered under Section A. Mental Health Services. Substance use disorders are covered under Section

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  • Food Service Waste Reduction Requirements Contractor shall comply with the Food Service Waste Reduction Ordinance, as set forth in San Francisco Environment Code Chapter 16, including but not limited to the remedies for noncompliance provided therein.

  • Export Requirements The Program, Documentation and all related technical information or materials are subject to export controls and U.S. Government export regulations. You will comply strictly with all legal requirements established under these controls and will not, in connection with its limited evaluation rights hereunder, export, re-export, divert, transfer or disclose, directly or indirectly the Program, Documentation and any related technical information or materials without the prior approval of the U.S.

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