Pharmacy Network. Administrator shall establish and maintain a network of pharmacies to service the Benefit Plans (the “Pharmacy Network”) that complies with all applicable Laws and Regulations. Once a month, Administrator shall make available to United a current list or data file of Network Pharmacies participating in the Pharmacy Network. The network files shall include data elements as specified by United and shall include, where available, the Medicaid ID# of the pharmacy provider for the state in which the provider is physically located. Administrator, upon notice to United, reserves the right to add or remove Network Pharmacies from the Pharmacy Network, provided that such changes comply with the requirements of applicable Laws and Regulations. Administrator will notify United plan members at least 30 days prior to termination of utilized Network Pharmacy and include a list of alternative pharmacies in the notification. Administrator agrees that United retains the right to approve, suspend or terminate the participation of any Network Pharmacy in the Pharmacy Network. Administrator shall make reasonable efforts to accommodate United’s request to add pharmacies to the Pharmacy Network. Administrator shall submit to United for approval any type of communication that Administrator intends to send to Network Pharmacies that uses or otherwise discloses any United brand and are solely related to the Services provided under this Agreement. Such communications shall be deemed approved by United if United does not provide comments or objections to Administrator within 2 business days following receipt.
Pharmacy Network. Brand Drugs Lower of U&C or AWP minus 15.50% plus $1.35 dispensing fee Generic MAC Drugs Lower of U&C, Catamaran MAC plus $1.35 dispensing fee Non-MAC Generic Drugs Lower of U&C or AWP minus 15.50% plus $1.35 dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 74.00% Year 2: AWP minus 74.50% Year 3: AWP minus 75.00% Year 4: AWP minus 75.50% Year 5: AWP minus 76.00% Retail Pharmacy Network (> 83) Brand Drugs Lower of U&C or AWP minus 18.50% plus $0.00 dispensing fee Generic MAC Drugs Lower of U&C, Catamaran MAC plus $0.00 dispensing fee Non-MAC Generic Drugs Lower of U&C or AWP minus 18.50% plus $0.00 dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 75.00% Year 2: AWP minus 75.50% Year 3: AWP minus 76.00% Year 4: AWP minus 76.50% Year 5: AWP minus 77.00% Catamaran Mail Service Pharmacy** Brand Drugs AWP minus 23.00% plus $0.00 dispensing fee Generic MAC Drugs Catamaran MAC plus $0.00 dispensing fee Generic Non- MAC Drugs AWP minus 23.00% plus $ 0.00 dispensing fee Effective Overall Generic Guarantee (ingredient cost) Year 1: AWP minus 76.00% Year 2: AWP minus 76.50% Year 3: AWP minus 77.00% Year 4: AWP minus 77.50% Year 5: AWP minus 78.00% TRADITIONAL MODEL YEAR ONE 2015 YEAR TWO 2016 YEAR THREE 2017 YEAR FOUR (if renewed) 2018 YEAR FIVE (if renewed) 2019 Specialty Pharmacy (Open) Dispensing Fees are $2.50 Rebates (Preferred 3-Tier, Catamaran Managed Formulary)*** Retail 30 Minimum Greater of 100% or $18.00 per Net Paid brand Claim Retail 90 Minimum Greater of 100% or $30.00 per Net Paid brand Claim Mail Minimum Greater of 100% or $50.00 per Net Paid brand Claim Specialty Minimum Greater of 100% or $18.00 per Net Paid specialty brand Claim **A minimum charge of $7.99 shall apply for all mail service orders. ***Contractor will pass through to County 100% of Rebates and Manufacturer Administrative Fees it receives that can be attributed to allowable utilization of Participants hereunder. Contractor shall retain other earned revenue which is deemed separate and apart from “Rebates” and “Manufacturer Administrative Fees.” Generic Dispensing Rate Guarantee Year 1 Year 2 Year 3 Year 4 (if renewed) Year 5 (if renewed) Retail 76.00% 77.00% 78.00% 78.00% 78.00% Mail 77.00% 78.00% 79.00% 79.00% 79.00%
Pharmacy Network. Administrator will maintain a pharmacy network, which shall meet the pharmacy access requirements set forth in 42 C.F.R §423.120, as applicable to EGWPs, or other requirements as mandated by the CMS Contract.
Pharmacy Network. The pharmacy management prescription drug 29 program offered by the third party administrator, containing a Milwaukee and 30 national network of pharmacies, shall be made available to all participants in the 31 comprehensive indemnity/PPO plan. Prescription medications obtained from 32 pharmacies in the network shall be subject to a ten percent (10%) co-pay off the 33 discounted amount payable to the network pharmacy at the time medications are 34 received. The third party administrator is solely responsible for establishing, 35 revising, and administering the pharmacy network. Participants in the 36 comprehensive indemnity/PPO plan shall be provided with a booklet listing the 37 pharmacies which belong to the pharmacy network. The booklet shall also be 38 provided to new plan participants upon enrollment and periodically to all 39 participants as updates are prepared. 2 Effective July 1, 2002, Viagra and similar medications shall be covered only 3 through participating pharmacies of the Aetna pharmacy network in accordance 4 with "Viagra endorsement" language agreed to by the parties (dated April 25, 5 2002) to include all subsequent standard Viagra endorsement changes made by the 6 third party administrator. Effective July 1, 2002, Viagra and similar medications 7 shall not be covered through the mail-order pharmacy program. 9 Effective July 1, 2002, appetite suppressant medications shall be covered only 10 through participating pharmacies of the Aetna pharmacy network in accordance
Pharmacy Network. The pharmacy management prescription 39 drug program offered by the TPA, containing a Milwaukee and national 1 network of pharmacies, shall be made available to all participants in the PPO 2 indemnity health plan. Prescription medications obtained from pharmacies in 3 the network shall be subject to a 10 percent co-pay off the discounted amount 4 payable to the network pharmacy at the time medications are received. The 5 TPA is solely responsible for establishing, revising, and administering the 6 pharmacy network. Participants in the PPO indemnity health plan shall be 7 provided with a booklet listing the pharmacies which belong to the pharmacy
Pharmacy Network. Our pharmacy network supports prescription routing, prescription refill requests, eligibility, medication history, formulary look-up and pharmacy claims to over 60,000 pharmacies. Our pharmacy network also sends patient- and drug-specific messages and alerts to pharmacies allowing them to better evaluate and address patient needs. In addition, Xxxxxx’s ability to connect to pharmacy benefit managers and payers allows us to meet the growing need for pharmacies to connect to medical payers as they implement new clinical services, such as flu shots and urgent care, that are covered as medical (not pharmacy) benefits. • Dental Network: Our dental network reaches over 105,000 dentists, over 500 payers and over 125 dental EHRs and other channel partners. We provide eligibility, claims, electronic remittance advice and payment solutions to dental practices primarily through software channel partners.
Pharmacy Network. (a) 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 periodically consolidates networks or migrates clients to other networks, in order to capitalize on certain operational efficiencies and other benefits associated with a streamlined network offering. ESI will notify Sponsor of any changes that would materially adversely affect Member access to Participating Pharmacies (e.g., a reduction of Participating Pharmacies in the network causing Sponsor’s Members’ access to in-state Participating Pharmacies to decrease by fifteen percent (15%) or more), and ESI will work with Sponsor in good faith to mitigate any such effects.
Pharmacy Network. Navitus has created and will maintain a network of Participating Pharmacies that will perform pharmacy services for Eligible Persons according to their Participating Pharmacy agreement. Although the composition of the Participating Pharmacy network may change due to the addition or withdrawal of specific Participating Pharmacies, Navitus will use commercially reasonable efforts to ensure that the network includes Participating Pharmacies such that the network will provide reasonable access and availability to the Eligible Persons.
Pharmacy Network. The Contractor shall provide a pharmacy network that complies with Special Contract Exhibit C requirements and at a minimum includes pharmacies licensed with the Iowa Board of Pharmacy.
Pharmacy Network
