Specialty Drugs. Charges for medications used to treat certain complex and rare medical conditions. Specialty drugs are often self-injected or self-administered. Many grow out of biotech research and may require refrigeration or special handling.
Specialty Drugs. ....means prescription drugs generally prescribed for use in limited patient populations or diseases. These drugs are typically in jected, but may also include high cost oral medications. In addition, patient support and/or education may be required for these drugs. The list of Special ty Drugs is subject to change. To determine which drugs are Specialty Drugs, you should contact your Pharmacy, refer to the Drug List by accessing the Web site at xxx.xxxxxx.xxx or call the Customer Service toll‐free number on your identification card.
Specialty Drugs. Community Health Options® has partnered with our Pharmacy Benefit Manager to implement a specialty drug program that: increases savings to our Members and the Plan; improves Member adherence; and allows Health Options’ Members 24/7 access to specialty-trained pharmacists and nurses to improve clinical outcomes. In order to pay the cost-sharing listed on your Schedule of Benefits for specialty drugs, they must be filled through our Preferred Specialty Pharmacy. The Preferred Specialty Pharmacy is established by Community Health Options and is subject to change at our discretion. These drugs are indicated on the Formulary as ‘mandatory specialty’. Specialty medications are limited to a 30-day supply, except where the medication is prepackaged and cannot be broken down into a smaller quantity. Certain specialty drugs are considered “mandatory” or “exclusive specialty” and must be filled through our Preferred Specialty Pharmacy, as defined on the Health Options Formulary. If you fill these prescriptions at a pharmacy that is not the Preferred Specialty Pharmacy, you will be responsible for 100% of the drug cost. These costs are not covered by the Plan and will not apply to your Out-of-Pocket costs. For certain specialty drugs the Plan offers one courtesy fill at a retail pharmacy as a covered benefit, as defined on the Health Options Formulary. Further fills of this specialty drug must be obtained directly through the exclusive specialty pharmacy, or you will be required to pay 100% of the allowed drug cost. In this case, the full allowed cost will apply to your Out-of-Pocket maximum.
Specialty Drugs. Caremark will be the exclusive provider of designated specialty drugs for Caremark plan participants.
Specialty Drugs. The MCO must develop policies and procedures for reclassifying prescription drugs from retail to specialty drugs for purposes of entering into selective contracting arrangements for specialty drugs. The MCO's policies and procedures must comply with 1 Tex. Admin. Code § 353.905 and § 354.1853 and include processes for notifying Network Pharmacy Providers.
Specialty Drugs. HHSC will adopt rules concerning specialty pharmacy services. Once HHSC adopts these rules, the MCO must develop policies and procedures for reclassifying prescription drugs from retail to specialty drugs. The MCO’s policies and procedures must be consistent with HHSC’s rules, and include processes for notifying Network Pharmacy Providers. As set forth in Section 8.1.4, the MCO may enter into selective contracts for specialty pharmacy services prior to HHSC’s adoption of rules concerning specialty pharmacy services, subject to the following conditions. These arrangements must comply with Texas Government Code §533.005(a)(23)(G). Furthermore, if these specialty pharmacy services contracts conflict with final rules promulgated by HHSC, then the MCO must terminate the contracts or amend them to comply with the rules.
Specialty Drugs. For more information please refer to the “Pre-certification Requirement and Prior Authorization Recommendation” section of this contract or call PIC at the phone number listed on the inside front cover of this contract.
Specialty Drugs. The TennCare pharmacy program described in this Agreement uses a rate table for Specialty Medications, defined as the Specialty Pharmaceutical Pricing List. The Specialty Pharmaceutical Pricing List is subject to periodic review by TennCare and/or PBM and may be modified at the discretion of TennCare. A link to the current Specialty Pharmaceutical Pricing List can be found at the website: xxxx://xxxxxxxxx.xxx/tenncare/pro-pharmacy.html. ABACUS # 13-228 4. RELATIONSHIP BETWEEN PARTIES
Specialty Drugs. Sponsor will pay MRx for Specialty Drugs that are Covered Pharmaceuticals dispensed through a Specialty Pharmacy or a Mail Order Pharmacy as set forth in Schedule B-1. MRx may add new Specialty Drugs to the Specialty Drug List as they become available in the market at a default price of AWP-11.00% for a 30- day supply until MRx establishes an appropriate contract price. MRx may retain discounts from manufacturers or wholesalers as a purchaser of pharmaceuticals and the price by paid Sponsor will not equal the price paid by MRx for Covered Pharmaceuticals. Subject to Section 4 below, MRx will provide the following financial guarantees for Specialty Drugs dispensed through the Specialty Pharmacy and the Mail Order Pharmacy: Component Minimum Specialty Drug Effective Rate (AWP Discount) Guarantee: AWP minus 19.00% Maximum Specialty Drug Dispensing Fee Guarantee: $0.00 Limited distribution drugs dispensed from a pharmacy other than an MRx Affiliate are excluded from the Specialty Drug guarantees.
Specialty Drugs. The TennCare pharmacy program described in this Agreement uses a rate table for Specialty Medications, defined as the Specialty Pharmaceutical Pricing List. The Specialty Pharmaceutical Pricing List is subject to periodic review by TennCare and/or PBM and may be modified at the discretion of TennCare. A link to the current Specialty Pharmaceutical Pricing List can be found at the website: xxxx://xxxxxxxxx.xxx/tenncare/pro-pharmacy.html. Magellan Pharmacy Solutions, Inc. TennCare Pharmacy NeAtwporrkiAl g3re,em2e0nt13 TDCI TennCare Division ABACUS # 13-228
