Pass-Through Pricing definition
Pass-Through Pricing means the model of prescription drug pricing in which a Pharmacy benefits manager charges the Health benefit plan the amount it actually pays a Pharmacist for prescription drug or device services plus an administrative fee charged on a per prescription or per member basis;
Pass-Through Pricing means the pharmacy benefit manager charges the CONTRACTOR for the amount paid to the pharmacy for a prescription drug, including a dispensing fee and an administrative fee. Patient-Centered Medical Home (PCMH) means an approach to delivering high-quality, cost-effective primary care. Using a patient-centered, culturally appropriate, and team-based approach, the PCMH model coordinates Member care across the health system. Guidelines for PCMH can be found in Guidelines for Patient-Centered Medical Home (PCMH) Recognition and Accreditation Programs (▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/system/files/documents/running_practice/delivery_and_payment_models/pcmh/understanding/guidelines_pcmh.pdf). Patient Protection and Affordable Care Act (PPACA) means Public Law 111-148 (2010) and the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152 (2010). Performance Measure (PM) means a regular measurement of outcomes and results, which generates reliable data on the effectiveness and efficiency of programs. Permanency Planning Worker (PPW) means the Child Protective Service (CPS) staff who plans, organizes, and coordinates the activities of the CPS Permanency Planning Program, a CYFD program responsible for conducting assessments and developing permanency plans for CISC to promote child safety, permanency, and wellbeing. The PPW conducts ongoing assessments to determine child safety, permanency, and well-being. The PPW visits with family members on a monthly basis to assess safety and to determine if the case plan is being implemented and services are effective.
Pass-Through Pricing means PBM agrees to pass-through 100% of negotiated discounts with network pharmacies at the point-of-service and to provide auditing protocol, enabling tracking of individual claims back to original pharmacy network contract documents. The PBM agrees to disclose details of all programs and services generating financial remuneration from outside entities.
More Definitions of Pass-Through Pricing
Pass-Through Pricing means that the Client’s cost for Participating Pharmacy prescription drug Claims, including Speciality Pharmaceuticals, is CastiaRx’ actual reimbursement cost to the Participating Pharmacies for such claims. CastiaRx’ Mail Pharmacy and Speciality Pharmacy charges to Client will be the actual guaranteed discounts set forth in Exhibit E. Rebates shall be the amount set forth in Exhibit E.
Pass-Through Pricing means the plan sponsor pays the actual contracted discounts and dispensing fees that the PBM has negotiated with the retail pharmacy network. The network rates negotiated by the PBM with pharmacy network providers are identical to the pricing invoiced to the plan sponsor. Sponsor acknowledges and agrees as follows: (1) IDEALSCRIPTS is authorized to receive and retain, as reasonable compensation, rebates from certain drug manufacturers as a result of the inclusion of such manufacturers’ products on the Plan’s formulary; (2) the prescription pricing charged by IDEALSCRIPTS as described in this Exhibit A may, in some cases, be different than the pricing charged by, and paid by IDEALSCRIPTS to, Member Pharmacies for such prescriptions; and (3) Sponsor shall be responsible for notifying Covered Persons of IDEALSCRIPTS receipt and retention of the foregoing.
Pass-Through Pricing means PBM agrees to pass-through 100% of negotiated discounts with network pharmacies at the point-of-service and to provide auditing protocol, enabling tracking of individual claims back to original pharmacy network contract documents. The
Pass-Through Pricing means the model of prescription drug pricing wherein a PBM charges the health benefit plan or covered entity the same price for a prescription drug that it pays the pharmacy for the same prescription drug.
Pass-Through Pricing means the pharmacy benefit manager charges the CONTRACTOR for the amount paid to the pharmacy for a prescription drug, including a dispensing fee and an administrative fee. Patient-Centered Medical Home (PCMH) means an approach to delivering high-quality, cost-effective primary care. Using a patient-centered, culturally appropriate, and team-based approach, the PCMH model coordinates Member care across the health system. Guidelines for PCMH can be found in Guidelines for Patient-Centered Medical Home (PCMH) Recognition and Accreditation Programs (▇▇▇▇▇://▇▇▇.▇▇▇▇▇▇▇▇▇.▇▇▇/system/files/documents/running_practice/delivery_and_payment_models/pcmh/understanding/guidelines_pcmh.pdf). Patient Protection and Affordable Care Act (PPACA) means Public Law 111-148 (2010) and the Health Care and Education Reconciliation Act of 2010 (Public Law 111-152 (2010). Permanency Planning Worker (PPW) means the Child Protective Service (CPS) staff who plans, organizes, and coordinates the activities of the CPS Permanency Planning Program, a CYFD program responsible for conducting assessments and developing permanency plans for CISC to promote child safety, permanency, and wellbeing. The PPW conducts ongoing assessments to determine child safety, permanency, and well-being. The PPW visits with family members on a monthly basis to assess safety and to determine if the case plan is being implemented and services are effective. Personal Care Services (PCS) means those services established by HSD to assist individuals twenty-one (21) years of age or older who are eligible for full Medicaid coverage and meet the level of care criteria as defined by policy. PCS are provided to a Member unable to perform a range of ADLs and instrumental activities of daily living (IADLs).
Pass-Through Pricing means that the Client’s cost for Participating Pharmacy prescription drug Claims, including
Pass-Through Pricing means PBM’s agreement that it shall not derive any profits whatsoever from the difference between amounts invoiced to NDPERS by PBM and amounts incurred by PBM for any Covered Item dispensed from any retail pharmacy, mail order pharmacy or specialty drug pharmacy (including the Mail Order Pharmacy and Specialty Drug Pharmacy). For purposes of clarification: For each pharmacy, PBM agrees to invoice for every Dispensed Claim - both for the Ingredient Cost and for the Dispensing Fee - the actual cost incurred by PBM. Said agreement includes those Covered Items included within Average Annual Guarantees, and those Covered Items excluded from Average Annual Guarantees. Pass-Through Pricing shall also mean PBM’s agreement to invoice for every Coordination of Benefit Claim based on PBM’s exact amount paid for the Covered Item. Pass-Through Pricing shall also mean PBM’s agreement that it shall invoice NDPERS for every vaccine, LTC dispensed, and home infusion therapy Covered Item based on PBM’s exact amount reimbursed for that Covered Item. Pass-Through Pricing shall also mean that PBM shall invoice NDPERS for every Compound Drug based on PBM’s exact reimbursement to the retail pharmacy for the Compound Drug, including PBM’s exact reimbursement for the compounding fee. In connection with Financial Benefits: Through Pricing shall mean PBM’s agreement that it shall pass through to NDPERS its Pro Rata Share of all Financial Benefits. Pass-Through Pricing shall also mean that PBM’s only profits shall be those that may be embedded in (i) Administrative Fees; and (ii) Additional Fees. Pharmacy Network – See Definition of “Participating Pharmacies.”