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All other pharmacies are NON-NETWORK PHARMACIES. The one exception and for the purpose of specialty Prescription Drugs, only specialty pharmacies that have an agreement to accept our pharmacy allowance are network pharmacies and all others pharmacies are non-network pharmacies.", "id": "network-pharmacy", "examples": ["Notes Tier <strong>Network pharmacy</strong> For a covered health care service you pay: Non-<strong>network pharmacy</strong> For a covered health care service you pay the difference between the charge amount and the allowance plus: Contraceptive methods \u2022 when purchased at a Mail Order Pharmacy Coverage includes barrier method (diaphragm or cervical cap), hormonal method (birth control pill), and emergency contraception.", "As described in Texas Government Code \u00a7 533.005(a-2), a MAC price list that is specific to a <strong>Network pharmacy</strong> is confidential for all other purposes.", "The MCO must provide a <strong>Network pharmacy</strong> the sources used to determine the MAC pricing at contract execution, renewal, and upon request.", "No later than March 1, 2014, the MCO must implement a process that allows a <strong>Network pharmacy</strong> to readily access the pharmacy&#x27;s MAC price through a website.", "The MCO must allow HHSC or its designee to contact <strong>Network pharmacy</strong> Providers to verify information submitted on claims, and upon HHSC\u2019s request, assist with this process.", "Notes Tier <strong>Network pharmacy</strong> For a covered health care service you pay: Non-<strong>network pharmacy</strong> For a covered health care service you pay the difference between the charge amount and the allowance plus: Specialty Prescription Drugs when purchased at a Specialty Pharmacy(+) Copayment applies per each 30-day supply or applies per recommended treatment interval.", "NO Type and Site of Service Benefit Limit/Notes Tier <strong>Network pharmacy</strong> For a covered health care service you pay: Non-<strong>network pharmacy</strong> For a covered health care service you pay the difference between the charge amount and the allowance plus: when purchased at a Retail or Specialty Pharmacy Glucometers, Test Strips, Lancet and Lancet Devices, and Miscellaneous Supplies (including calibration fluid).", "Contractor Book of Business &gt;= 99.5% <strong>Network pharmacy</strong> access Contractor guarantees that 98% of members will have at least one (1) participating pharmacy within 1.5 miles urban, three (3) miles suburban or ten (10) miles rural of their home zip code (where a pharmacy exists within the specified standard)Measure and reconcile annually and based on client specific data.", "<strong>Network pharmacy</strong> access As measured by the number of Client members with access to a retail <strong>network pharmacy</strong> within one (1) mile urban, three (3) miles suburban or ten (10) miles rural of their home zip code (where a pharmacy exists within the specified standard), divided by the total number of Client members.", "Following implementation, enrollees may fill no less than one prescription for a drug included in the Specialty Program at a Non-Specialty <strong>Network pharmacy</strong>, except for those drugs identified as being used for short-term therapy for which a delay in starting therapy would not affect clinical outcome."], "related": [["network-user", "Network User", "Network User"], ["pharmacy", "Pharmacy", "Pharmacy"], ["network-operator", "Network Operator", "Network Operator"], ["network-plan", "Network plan", "Network plan"], ["integrated-services-digital-network-isdn", "Integrated Services Digital Network (ISDN)", "Integrated Services Digital Network (ISDN)"]], "related_snippets": [], "updated": "2025-07-18T05:45:24+00:00"}, "json": true, "cursor": ""}}