Common use of Pharmacy appeals Clause in Contracts

Pharmacy appeals. Pharmacy appeals and Pharmacy Lock-In Program appeals must identify the matter being appealed and should include the member’s (and dependent’s, if applicable) name, the date the member attempted to fill the pre- scription, the prescribing physician’s name, the drug name and quantity, the cost of the prescription, if applicable, and any applicable reason(s) relevant to the appeal including: the reason(s) the member believes the claim should be paid, the reason(s) the member believes s/he should not be included in the Pharmacy Lock-In Program, and any other written documentation to support the mem- ber’s belief that the original decision should be overturned.