Participating Pharmacies Clause Examples
The Participating Pharmacies clause defines which pharmacies are authorized to take part in a specific program, agreement, or network. It typically outlines the criteria that pharmacies must meet to be included, such as licensing requirements, compliance with certain standards, or execution of participation agreements. This clause ensures that only qualified and approved pharmacies are involved, thereby maintaining quality control and regulatory compliance within the program.
Participating Pharmacies. The PBM’s Participating Pharmacies are available to Enrollees who use medically necessary drugs Participating mail service pharmacies have toll free access to registered pharmacists to answer your questions. Participating specialty pharmacies have dedicated patient care coordinators to help You manage Your condition and offer toll-free twenty-four hour access to nurses and registered Pharmacists. You may obtain a list of the Participating Pharmacies, and Covered Drugs, by calling the Customer Service telephone number on the back of Your ID card, or review the lists on Our website at ▇▇▇.▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇. Covered Prescription Drug Benefits include the following. Prescription Legend Drugs. Injectable insulin and syringes used for administration of insulin. Oral contraceptive Drugs, injectable contraceptive drugs and patches are Covered when obtained through an eligible Pharmacy. If certain supplies, equipment or appliances are not obtained by Mail Service or from a Participating Pharmacy then they are Covered as Medical Supplies, Equipment and Appliances instead of under Prescription Drug benefits and may be subject to applicable DME Copays or Coinsurance. Injectables. Medical food that is Medically Necessary and prescribed by a Physician for the treatment of an inherited metabolic disease. Medical food means a formula that is intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and formulated to be consumed or administered enterally under the direction of a Physician. Non-Covered Prescription Drug Benefits Prescription Drugs dispensed by any Mail Service program other than the PBM’s Mail Service, unless prohibited by law. Drugs, devices and products, or Prescription Legend Drugs with over the counter equivalents and any Drugs, devices or products that are therapeutically comparable to an over the counter Drug, device, or product. Off label use, except as otherwise prohibited by law or as approved by Us or the PBM. Drugs in quantities exceeding the quantity prescribed, or for any refill dispensed later than one year after the date of the original Prescription Order. Drugs not approved by the FDA. Charges for the administration of any Drug. Drugs consumed at the time and place where dispensed or where the Prescription Order is issued, including but not limited to samples provided by a Physician. This does not apply to Drugs used in conjunction with ...
Participating Pharmacies. ESI will maintain a network(s) of Participating Pharmacies as identified in Exhibit A, and will make available an updated list of Participating Pharmacies on-line. ESI maintains multiple networks and subnetworks, and periodically consolidates networks or migrates clients to other networks and subnetworks. If, due to an access concern, Sponsor requests that ESI attempt to add a particular retail pharmacy to the network of Participating Pharmacies serving Sponsor and its Members hereunder, ESI will make commercially reasonable efforts to add any such pharmacy to the Participating Pharmacy network for Sponsor, provided that such pharmacy meets ESI’s network participation requirements and agrees to ESI’s standard terms and conditions. If any such pharmacy meets ESI’s network participation requirements and agrees to ESI’s standard terms and conditions except for ESI’s standard network rates (i.e., the particular pharmacy will only agree to higher than standard reimbursement rates), and Sponsor nevertheless requests that ESI add such pharmacy, the rate charged to Sponsor for Prescription Drug Claims processed through such pharmacy (assuming ESI agrees to contract with such pharmacy) will be the net ingredient cost plus the dispensing fee paid by ESI to such Participating Pharmacy (plus applicable sales or excise tax or other governmental surcharge, if any). All such Prescription Drug Claims will be excluded from the pricing guarantees set forth in Exhibit A.
(i) ESI will require each Participating Pharmacy to meet ESI’s network participation requirements, including but not limited to licensure, insurance and provider agreement requirements. ESI also provides a standard suite of pharmacy audit services to determine Participating Pharmacies’ compliance with their provider agreement billing requirements. ESI will attempt recovery of identified overpayments through offset, demand or other reasonable means; provided that ESI will not be required to institute litigation. Recovered overpayments are credited to Sponsor. Copies of participation requirements and auditing processes are available upon request.
(ii) ESI does not direct or exercise any control over the Participating Pharmacies or the professional judgment exercised by any pharmacist in dispensing prescriptions or otherwise providing pharmaceutical related services at a Participating Pharmacy. ESI shall have no liability to Sponsor, any Member or any other person or entity for any act or omission of any Partic...
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Participating Pharmacies. Client shall not be eligible for rebates with respect to prescriptions under the Rebate Program if Participating Pharmacies are obligated or provided a financial incentive to follow or comply with a drug formulary other than the Formulary in connection with providing services for Participants of CarePlus.
Participating Pharmacies. Sponsor acknowledges and agrees that neither PBM, nor its shareholders, directors, officers or employees have any liability whatsoever to Sponsor or Members for the acts or omissions of any Participating Pharmacy (including, but not necessarily limited to, the acts or omissions of any Participating Pharmacy’s employees or agents) in connection with such Participating Pharmacy’s provision of services to Sponsor or Members, including, but not necessarily limited to, any of the following: (i) any actual or alleged malpractice, negligence or misconduct of any Participating Pharmacy; or (ii) the sale, compounding, dispensing, failure to sell, manufacture or use of any drug dispensed to a Member under this Agreement.
Participating Pharmacies. ▇▇▇▇▇▇▇▇ who till prescriptions at a non-patricipating pharmacy art tesgousible for payment at the time the prescription is filled. Members must submit claims to Anthem Blue Gross and Blue Shield for reimburi-ement, and payment will he sent to the member. lvferntx.ns who use non-participating pharmacies will pay 20% of the ill•WV..Orii allowance, plus the difference between Anthem Blue Cross and Blue Shield's payment and the pharmacist's actual charge.
Participating Pharmacies. If no adjudication rates are specified herein, each claim will be adjudicated to Sponsor at the applicable ingredient cost, and will be reconciled to the applicable guarantee as set forth herein. The discounted ingredient cost will be the lesser of MRA (as applicable), U&C or the applicable AWP discount.
Participating Pharmacies. The Participating Pharmacy will submit a claim for Benefits directly to the PBM. Members will not need to submit a claim. Payment for Benefits – after applicable Cost-Sharing Amounts, if any - is made directly to that Participating Pharmacy.
Participating Pharmacies. The amount paid to the Participating Pharmacy for Prescription Drug Claims may or may not be equal to the amount charged to Employer, and BlueCross will absorb any negative margin or retain any positive margin. Subject to applicable law, BlueCross may communicate with Members regarding benefit design, cost savings, availability and use of the selected networks, as well as provide supporting services. A list of Participating Pharmacies is available to Members on-line. BlueCross does not direct or exercise any control over the professional judgment exercised by any pharmacist providing pharmaceutical related services.
Participating Pharmacies. AdvancePCS has created a network of Participating Pharmacies, which will perform pharmacy services for Participants.