PBM Operations definition

PBM Operations means the operations conducted by CVS Caremark in its capacity as a PBM in the United States for health plan sponsors, including the processing of Third-Party Liability Claims and other prescription drug claims; implementation of client plan designs; administration of formularies; offering of retail pharmacy networks; and negotiation of discounts and rebates with drug manufacturers.
Sample 1

Examples of PBM Operations in a sentence

  • Transparency of PBM Operations and Pricing In contrast to expanding efforts by the federal government to make healthcare prices more public, little is known about PBM financial arrangements.32 Scarce information is available about the size and frequency of rebates PBMs receive from manufacturers, nor is it understood the extent to which patients experience actual benefits of these rebates and discounts.

  • Underfactor (4), PBM Operations, the SSA noted that ACS received moderate risk ratings for four of the five subfactors, whereas ESI received all low risk ratings; discussed in detail the significant discriminators between ACS’s and ESI’s approaches under these subfactors; and concluded that ESI had the better technical proposal under this factor.

  • PharmaCare’s proposal was also rated as green with a low risk under factor (4), PBM Operations.

  • The awardee’s and protesters’ proposals were evaluated as follows: Offeror(1) Network Access(2) Network Reimbursement(3) PBM Services(4) PBM Operations (5) Past Performance15 (6)PriceMerit/RiskDisruption Agency Report, Book 15, Tab 37, SSEB Evaluation Report, at 10.

  • The Bidder must specify a firm fixed price to perform all PBM Operations services for the initial base contract year.

  • Under factor (4), PBM Operations, ESI’s proposal also received an overall green with low risk rating.

  • Factor (4) PBM Operations Prior Authorization and Medical Necessity Determination Subfactors ACS argues that the agency misevaluated its and ESI’s proposal under the prior authorization and medical necessity determination subfactors, for which ACS’s proposal was rated as green with moderate risk and ESI’s blue with low risk.

  • We need not address this issue because, even accepting PGBA’s argument that its proposal of a dedicated [Deleted] and [Deleted] should be viewed as proposal strengths, this would not have changed its overall rating under factor (4), PBM Operations.

  • Agency Report, Book 15, Tab 36, Source Selection Decision, at 18; see Agency Report, Book 3, Tab 8, ESI Technical Proposal, Oral Presentation Slide 37.ESI/PGBA Tradeoff Comparing ESI’s and PGBA’s proposals, the SSA noted that ESI’s proposal was assessed as more advantageous than PBGA’s proposal under factors (4), PBM Operations, and (5), Past Performance.

  • For purposes of this CIA, a “Third-Party Liability Underpayment” shall mean, following submission by a Federal health care program (or its designee) of a Third-Party Liability Claim to CVS Caremark after the Effective Date, the amount that should have been, but was not, reimbursed to the Federal health care program for that claim on behalf of a PBM client due to a processing or other error occurring on a PBM Operations platform.

Related to PBM Operations

  • System Operations means the Power Producer's operation; maintenance and repair of the System performed in accordance the requirement herein.

  • Production Operations means all operations conducted for the purpose of producing Petroleum from the Development Area after the commencement of production from the Development Area including the operation and maintenance of all necessary facilities therefor.

  • Petroleum Operations means, as the context may require, Exploration Operations, Development Operations or Production Operations or any combination of two or more of such operations, including construction, operation and maintenance of all necessary facilities, plugging and abandonment of Xxxxx, safety, environmental protection, transportation, storage, sale or disposition of Petroleum to the Delivery Point, Site Restoration and any or all other incidental operations or activities as may be necessary.

  • Farm operation means any activity conducted solely or primarily for the production of one or more agricultural products or commodities, including timber, for sale or home use, and customarily producing such products or commodities in sufficient quantity to be capable of contributing materially to the operator's support.

  • Business operations means engaging in commerce in any form, including by acquiring, developing, maintaining, owning, selling, possessing, leasing, or operating equipment, facilities, personnel, products, services, personal property, real property, or any other apparatus of business or commerce.

  • Branch operations means any business operations of a branch captive insurance company in this State.

  • Exploration Operations means operations conducted in the Contract Area pursuant to this Contract in searching for Petroleum and in the course of an Appraisal Programme and shall include but not be limited to aerial, geological, geophysical, geochemical, palaeontological, palynological, topographical and seismic surveys, analysis, studies and their interpretation, investigations relating to the subsurface geology including structural test drilling, stratigraphic test drilling, drilling of Exploration Xxxxx and Appraisal Xxxxx and other related activities such as surveying, drill site preparation and all work necessarily connected therewith that is conducted in connection with Petroleum exploration.

  • Salvage operation means any business, trade or industry engaged in whole or in part in salvaging or reclaiming any product or material, including but not limited to metals, chemicals, shipping containers or drums.

  • Drilling operations means the drilling of an oil and gas well and the production and completion operations ensuing from the drilling which require entry upon the surface estate and which were commenced after June 30, 1979, and oil and gas geophysical and seismograph exploration activities commenced after June 30, 1983.

  • Operations means all the activities conducted by PURCHASER under this contract, including project work, logging, or post harvest activities; or the furnishing of all materials, equipment, labor, and incidentals necessary to successfully complete any individual item or the entire contract.

  • Mining Operations means every kind of work done by the Operator:

  • Railway Operation means the construction and operation under this Agreement of the relevant Railway and associated access roads and Additional Infrastructure (if any) within the relevant Railway Corridor and of the associated Lateral Access Roads, in accordance with approved proposals;

  • Discontinued Operations means operations that are accounted for as discontinued operations pursuant to Applicable GAAP of the Issuer for which the Disposal of such assets has not yet occurred.

  • economic operators means the manufacturer, the authorised representative, the importer and the distributor;

  • Development Operations means operations conducted in accordance with the Development Plan and shall include, but not be limited to the purchase, shipment or storage of equipment and materials used in developing Petroleum accumulations, the drilling, completion and testing of Development Xxxxx, the drilling and completion of Xxxxx for Gas or water injection, the laying of gathering lines, the installation of offshore platforms and installations, the installation of separators, tankages, pumps, artificial lift and other producing and injection facilities required to produce, process and transport Petroleum into main Oil storage or Gas processing facilities, either onshore or offshore, including the laying of pipelines within or outside the Contract Area, storage at Delivery Point(s), the installation of said storage or Gas processing facilities, the installation of export and loading facilities and other facilities required for the development and production of the said Petroleum accumulations and for the delivery of Crude Oil and/or Gas at the Delivery Point and also including incidental operations not specifically referred to herein but required for the most efficient and economic development and production of the said Petroleum accumulations in accordance with modern oilfield and petroleum industry practices.

  • Maintenance and Operations Revenue or “M&O Revenue” means (i) those revenues which the District receives from the levy of its annual ad valorem maintenance and operations tax pursuant to Section 45.002 of the TEXAS EDUCATION CODE, or other lawful authority, and Article VII § 3 of the TEXAS CONSTITUTION, plus (ii) all State revenues to which the District is or may be entitled under the applicable provisions of the TEXAS EDUCATION CODE or any other statutory provision as well as any amendment or successor statute to these provisions, as applicable, less

  • Health Care Operations shall have the meaning given to such term under the HIPAA 2 Privacy Rule in 45 CFR § 164.501.

  • Market Operations Center means the equipment, facilities and personnel used by or on behalf of a Market Participant to communicate and coordinate with the Office of the Interconnection in connection with transactions in the PJM Interchange Energy Market or the operation of the PJM Region.

  • Financial Services Business for purposes of this Unit Agreement shall mean the business of banking, including deposit, credit, trust and investment services, mortgage banking, asset management, and brokerage and investment banking services. (C) The term "Managerial Responsibilities" for purposes of this Unit Agreement shall mean managerial and supervisory responsibilities and duties that are substantially the same as that Grantee is performing for SunTrust or a SunTrust Affiliate on the date of this Unit Agreement. (D) The term "SunTrust Affiliate" for purposes of this Unit Agreement shall mean any corporation which is a subsidiary corporation (within the meaning of §424(f) of the Code) of SunTrust except a corporation which has subsidiary corporation status under §424(f) of the Code exclusively as a result of SunTrust or a SunTrust Affiliate holding stock in such corporation as a fiduciary with respect to any trust, estate, conservatorship, guardianship or agency. (E) The term "Territory" for purposes of this Unit Agreement shall mean the states of Alabama, Florida, Georgia, Maryland, North Carolina, South Carolina, Tennessee, Virginia, and the District of Columbia, which are the states and Territories in which SunTrust has significant operations on the date of this Unit Agreement. (F) "Trade Secret" for purposes of Unit Agreement shall mean information, including, but not limited to, technical or nontechnical data, a formula, a pattern, a compilation, a program, a device, a method, a technique, a drawing, a process, financial data, financial plans, product plans, or a list of actual or potential customers or suppliers that: (i) derives economic value, actual or potential, from not being generally known to, and not being readily ascertainable by proper means by, other persons who can obtain economic value from it is disclosure or use, and (ii) is the subject of reasonable efforts by SunTrust or a SunTrust Affiliate to maintain its secrecy.

  • Generation Operations Center means the location of Buyer’s real-time operations personnel.

  • Cash from Operations means the net cash realized by the Company from any source other than a Capital Transaction, after payment of all cash expenditures of the Company, including, but not limited to, all operating expenses including all fees payable to the Manager or Affiliates, all payments of principal and interest on indebtedness, expenses for repairs and maintenance, capital improvements and replacements, and such reserves and retentions as the Manager reasonably determines to be necessary and desirable in connection with Company operations with its then existing assets and any anticipated acquisitions.

  • AREA OF OPERATIONS means the Company's oilfield operations in the States of Assam and Arunachal Pradesh.

  • Gross Income from Operations means all sustainable income as reported on the financial statements delivered by the Borrower in accordance with this Agreement, computed in accordance with accounting principles reasonably acceptable to Lender, consistently applied, derived from the ownership and operation of the Property from whatever source, INCLUDING, but not limited to, (i) Rents from Tenants that are in occupancy, open for business and paying unabated Rent, (ii) utility charges, (iii) escalations, (iv) intentionally omitted; (v) service fees or charges, (vi) license fees, (vii) parking fees, and (viii) other required pass-throughs but EXCLUDING (i) Rents from Tenants that are subject to any bankruptcy proceeding (unless such Tenant has affirmed its Lease or Inland Western Retail Real Estate Trust, Inc. has master leased such Tenant's premises for full contract rent for a period not less than three years, and the net worth of Inland Western Retail Real Estate Trust, Inc. (as determined by Lender) is not less than such entity's net worth as of September 30, 2003), or are not in occupancy, open for business or paying unabated Rent, (ii) sales, use and occupancy or other taxes on receipts required to be accounted for by Borrower to any Governmental Authority, (iii) refunds and uncollectible accounts, (iv) sales of furniture, fixtures and equipment, (v) Insurance Proceeds (other than business interruption or other loss of income insurance), (vi) Awards, (vii) unforfeited security deposits, (viii) utility and other similar deposits and (ix) any disbursements to Borrower from the Reserve Funds. Gross income shall not be diminished as a result of the Mortgage or the creation of any intervening estate or interest in the Property or any part thereof.

  • Gross Operating Profit For any Fiscal Year, the excess of Gross Revenues for such Fiscal Year over Gross Operating Expenses for such Fiscal Year.

  • Operations Plan means the document by which PURCHASER notifies STATE of the plans and schedule for completing the operations described in the contract. It also contains the names of the subcontractors, PURCHASER's Authorized Representatives, and STATE's Authorized Representatives. Permit means any permit required by a federal, state, or local government agency before operations under this contract may lawfully begin or continue. Permit includes an incidental take permit under the federal Endangered Species Act.

  • Revenue Operations Date (ROD) means the date of operation of Metro