BHS PROGRAM Sample Clauses

BHS PROGRAM. RX BENEFIT DESIGN 20 1. CONTRACTOR shall reimburse only those medications that are on the BHS Program 21 formulary which shall be developed and maintained by the BHS Program. The COUNTY, through the 22 BHS Program is the payer of last resort for medically necessary medications in the treatment of mental 23 illness prescribed by Authorized BHS Program Prescribers. BHS Program maintains a formulary 24 restricted to generic formulations when they are available. 25 2. The ADMINISTRATOR or the PBM Auditor shall provide the BHS Program Formulary 26 and any modifications thereafter to CONTRACTOR. For reference only, the most current BHS 27 Program Formulary should be posted by the ADMINISTRATOR on the BHS website at: 28 xxxx://xxxxxxxxxxxx.xxx/bhs/about/formulary. 29 3. In order to ensure that therapeutic integrity is maintained in the face of cost considerations, 30 only generics rated as therapeutically equivalent (so-called “A” or “AB rated”), or rated equivalent to 31 the pioneer product by the FDA are covered. 32 4. ADMINISTRATOR, in rare cases, may cover a non-formulary drug when approved in 33 writing by the ADMINISTRATOR. 34 5. CONTRACTOR agrees that reimbursement of any medications authorized outside the 35 scope of the BHS Program formulary, without a proper prior authorization from the 36 ADMINISTRATOR, will result in an audit exception and funds withheld from CONTRACTOR in 37 accordance with Exhibit D to the Agreement. 1 6. CONTRACTOR agrees that all medications must be provided by the Network of 2 Pharmacies provided by the CONTRACTOR. CONTRACTOR shall provide its Pharmacy Benefits 3 Management services based on the following BHS Program guidelines. Failure to do so without proper 4 authorization from the ADMINISTRATOR will result in an audit exception and funds withheld from 5 CONTRACTOR in accordance with Exhibit C to this Agreement. 6 7. CONTRACTOR agrees that all medications available in generic formulations must be 7 prescribed as generic. If a physician prescribes a brand name product, then the pharmacy is expected to 8 substitute with a generic formulation when one is available unless a prior authorization is provided by 9 ADMINISTARTOR to the CONTRACTOR. 10 8. CONTRACTOR agrees that all medications on the formulary have a quantity limit on the 11 number of units covered in a month’s supply, and a dollar limit on the maximum payment that BHS will 12 approve. These quantity limits and maximum dollar thresholds are formulary limits on the usual ...
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BHS PROGRAM. PHARMACY NETWORK MANAGEMENT 34 1. CONTRACTOR shall distribute informational materials to the Participating Pharmacies if 35 the BHS Program plan design changes or other network changes are made. Such communications shall 36 be approved by ADMINISTRATOR before distribution to the Participating Pharmacies. 37 // 1 2. CONTRACTOR shall routinely communicate, upon approval of the ADMINISTRATOR, 2 policies and procedures regarding new drugs, therapeutic substitution, utilization management, and 3 adjudication standards and practices (particularly relating to coordination of benefits) to pharmacies in 4 the network. 5 3. CONTRACTOR agrees that any communications referencing the BHS Program shall be 6 approved by the ADMINISTARTOR, including educational materials, before any materials are 7 distributed to the pharmacy network. Educational materials that may be specifically related to the BHS 8 Program include: 9 a. Formulary and preferred drug lists; 10 b. Policies & procedures related to claims submission; 11 c. New product notifications; 12 d. Communication of new clinical guidelines; 13 e. Policies & procedures related to prior authorizations; 14 f. Patient compliance reminders; 15 g. MAC program details; 16 h. Policies & procedures related to member grievances; and 17 i. Benefits of optimizing generic drugs 18 4. CONTRACTOR shall manage Participating Pharmacy relationships, including 19 credentialing and contracting, which encompasses pharmacy program compliance, contractual disputes, 20 and re-credentialing. 21 a. CONTRACTOR may be requested by the ADMINISTRATOR to go into local areas to 22 better communicate with and educate pharmacists on issues that directly impact the BHS Clients being 23 served. 24 b. CONTRACTOR shall periodically survey pharmacies in order to better monitor the 25 satisfaction and needs of network pharmacies and shall share the results of these surveys with
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BHS PROGRAM. 1. Act as a liaison between the PBM and BHS Program, as necessary, for day-to-day questions, concerns, or operational issues; 2. Establish Clinical Practice Guidelines/Best Practices Development for the MRC; 3. As requested by County, personally attend meetings when deemed necessary; and 4. Periodic financial review of BHS Program expenditures, invoice analyses, and any discrepancies noted.
Sample 1
BHS PROGRAM. PHARMACY NETWORK MANAGEMENT 34 1. CONTRACTOR shall distribute informational materials to the Participating Pharmacies if 35 the BHS Program plan design changes or other network changes are made. Such communications shall 36 be approved by ADMINISTRATOR before distribution to the Participating Pharmacies. 37 // 1 2. CONTRACTOR shall routinely communicate, upon approval of the ADMINISTRATOR, 2 policies and procedures regarding new drugs, therapeutic substitution, utilization management, and 3 adjudication standards and practices (particularly relating to coordination of benefits) to pharmacies in 4 the network. 5 3. CONTRACTOR agrees that any communications referencing the BHS Program shall be 6 approved by the ADMINISTARTOR, including educational materials, before any materials are 7 distributed to the pharmacy network. Educational materials that may be specifically related to the BHS 8 Program include: 9 a. Formulary and preferred drug lists; 10 b. Policies & procedures related to claims submission; 11 c. New product notifications; 12 d. Communication of new clinical guidelines; 13 e. Policies & procedures related to prior authorizations; 14 f. Patient compliance reminders; 15 g. MAC program details; 16 h. Policies & procedures related to member grievances; and 17 i. Benefits of optimizing generic drugs
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Related to BHS PROGRAM

  • Educational Program A. DSST PUBLIC SCHOOLS shall implement and maintain the following characteristics of its educational program in addition to those identified in the Network Contract at DSST XXXX MIDDLE SCHOOL (“the School” within Exhibit A-3). These characteristics are subject to modification with the District’s written approval:

  • HEALTH PROGRAM 3701 Health examinations required by the Employer shall be provided by the Employer and shall be at the expense of the Employer. 3702 Time off without loss of regular pay shall be allowed at a time determined by the Employer for such medical examinations and laboratory tests, provided that these are performed on the Employer’s premises, or at a facility designated by the Employer. 3703 With the approval of the Employer, a nurse may choose to be examined by a physician of her/his own choice, at her/his own expense, as long as the Employer receives a statement as to the fitness of the nurse from the physician. 3704 Time off for medical and dental examinations and/or treatments may be granted and such time off, including necessary travel time, shall be chargeable against accumulated income protection benefits.

  • The Program The Program is a comprehensive commercial energy efficiency program that offers financial incentives and financing for qualifying energy efficiency measures in commercial buildings to customers who are property owners, tenants or managers (customers) of ACE in New Jersey. Customers must receive ACE electric delivery service and be in good standing. Incentives are available to customers for the purchase and installation of qualifying energy-efficiency measures at the location where the qualifying project is to be installed. ACE will not offer financial incentives for the same eligible measure to those customers who have received financial incentives or rebates from other ACE energy efficiency programs.

  • Safety Program The Contractor shall design a specific safety program for the Work for the site(s). The Contractor shall establish and require all Subcontractors to establish reasonable safety programs. The Contractor shall also submit its standard monthly safety reports to the Owner and Design Professional. No imposition of responsibility on the Contractor for safety under this Contract shall relieve any subcontractor of its responsibility for safety of persons or property on or near the Project Site. The Contractor shall include in his plant he names of the person in charge of Safety.

  • Development Plans Customer has provided Provider with a report attached hereto as Exhibit D (the “Current Development Plan”) describing in detail, as of January 1, 2017, the planned development, drilling, production, processing, treating, marketing and other activities to take place with respect to Dedicated Production and Customer Injected NGLs for the applicable Development Period. The information contained in the Current Development Plan is, with respect to the first three Years covered by the Current Development Plan, on a Quarter-by-Quarter basis, and with respect to the remaining Years covered by the Current Development Plan, on a Year-by-Year basis. The Current Development Plan attached hereto has been approved by the Parties. (a) From time to time during each Year of the Term, the Parties shall meet to discuss the planned development, drilling, production, processing, treating, marketing and other activities that Customer expects to take place with respect to Dedicated Production and Customer Injected NGLs for the then-applicable Development Period. Customer and Provider shall each make their respective representatives available to participate in such meetings and discussions. No later than August 1 of each such Year, Customer shall provide (or cause to be provided) to Provider a proposed update of the then-currently agreed Development Plan, prepared on the same basis as the Current Development Plan and describing in detail the planned development, drilling, production, processing, treating, marketing and other activities to take place with respect to Dedicated Production and Customer Injected NGLs for the then-applicable Development Period (any such update, an “Updated Development Plan” and, together with the Current Development Plan, each, a “Development Plan”). (b) Each proposed Development Plan shall include information as to the following, in each case, broken out, with respect to the first three Years covered by such Development Plan, on a Quarter-by-Quarter basis, and, with respect to the remaining Years covered by such Development Plan, on a Year-by-Year basis: (i) forward-looking production estimates for the applicable time period covered by such Development Plan for all Customer Gas and Customer Injected NGLs (A) that Customer reasonably and in good faith believes will become owned or Controlled by Customer during the time period covered by such Development Plan, and/or (B) that will be produced from (I) in the aggregate, all Xxxxx then-existing and (II) in the aggregate, all Xxxxx that are expected to be drilled during the time period covered by such Development Plan (each such Well reflected in such Development Plan, a “Planned Well” and, such collective estimates described in subsections (A) and (B), both with respect to a particular Quarter and an entire Year, the “Dedicated Production Estimates”); TERMS IN THIS EXHIBIT HAVE BEEN REDACTED BECAUSE CONFIDENTIAL TREATMENT FOR THOSE TERMS HAS BEEN REQUESTED. THE REDACTED MATERIAL HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION, AND THE TERMS HAVE BEEN MARKED AT THE APPROPRIATE PLACE WITH TWO ASTERISKS (**). (ii) (A) each new receipt point (including the location thereof) proposed by Customer with respect to the Dedicated Production Estimate reflected in such Development Plan (each such receipt point, a “Planned Receipt Point”), (B) each Receipt Point at which Customer expects to Tender Customer Gas or Customer Injected NGLs reflected in such Development Plan into the TGP System, and (C) the estimated portion of the Dedicated Production Estimate contained in such Development Plan that Customer expects to Tender at each such Receipt Point and Planned Receipt Point; (iii) (A) each new delivery point (including the location thereof) proposed by Customer with respect to the Dedication Production Estimate reflected in such Development Plan (each such delivery point, a “Planned Delivery Point”), (B) each Delivery Point at which Customer expects to Nominate Customer Residue Gas or Customer NGLs produced from the Dedicated Production Estimate reflected in such Development Plan to be redelivered to Customer, and (C) the estimated volumes of Customer Residue Gas and Customer NGLs produced from the Dedication Production Estimate contained in such Development Plan that Customer expects to Nominate to each such Delivery Point; (iv) the earliest date on which each Planned Receipt Point and Planned Delivery Point included in the Development Plan is required by Customer to be placed into service, which date shall not be earlier than three Months after the January 1st that is immediately subsequent to the date that the Development Plan that initially reflected such Planned Receipt Point or Planned Delivery Point was delivered to Provider hereunder; (v) the anticipated characteristics of the production from the Xxxxx and Planned Xxxxx reflected in such Development Plan (including liquids content and gas and liquids composition) and the projected production volumes and production pressures applicable thereto; provided that Customer may utilize the existing and historical production information from similarly situated Xxxxx; (vi) any (A) proposed revision to the then-existing Dedicated Area and/or any then-existing Dedicated Contract and/or (B) any new contract that Customer proposes to be a Dedicated Contract; and (vii) other information reasonably requested by Provider that is relevant to the design, construction, and operation of the TGP System, including (A) any applicable Plant Expansion or Facilities Modification proposed by Customer, (B) the relevant Receipt Point and Planned Receipt Point facilities applicable to such Development Plan, and (C) the relevant Delivery Point and Planned Delivery Point facilities applicable to such Development Plan. TERMS IN THIS EXHIBIT HAVE BEEN REDACTED BECAUSE CONFIDENTIAL TREATMENT FOR THOSE TERMS HAS BEEN REQUESTED. THE REDACTED MATERIAL HAS BEEN FILED SEPARATELY WITH THE SECURITIES AND EXCHANGE COMMISSION, AND THE TERMS HAVE BEEN MARKED AT THE APPROPRIATE PLACE WITH TWO ASTERISKS (**).

  • Marketing Plans Contractor and the Exchange recognize that Enrollees and other health care consumers benefit from efforts relating to outreach activities designed to increase heath awareness and encourage enrollment. The parties shall share marketing plans on an annual basis and with respect to periodic updates of material changes. The marketing plans of each of the Exchange and Contractor shall include proposed marketing approaches and channels and shall provide samples of any planned marketing materials and related collateral as well as planned, and when completed, expenses for the marketing budget. The Contractor shall include this information for both the Exchange and the outside individual market. The Exchange shall treat all marketing information provided under this Section as confidential information and the obligation of the Exchange to maintain confidentiality of this information shall survive termination or expiration of this Agreement.

  • Pilot Programs The Employer may develop voluntary pilot programs to test the acceptability of various risk management programs. Incentives for participation in such programs may include limited short-term improvements to the benefits outlined in this Article. Implementation of such pilot programs is subject to the review and approval of the Joint Labor-Management Committee on Health Plans.

  • Program 3.01. The Borrower declares its commitment to the Program and its implementation. To this end, and further to Section 5.08 of the General Conditions: (a) the Borrower and the Bank shall from time to time, at the request of either party, exchange views on the Borrower’s macroeconomic policy framework and the progress achieved in carrying out the Program; (b) prior to each such exchange of views, the Borrower shall furnish to the Bank for its review and comment a report on the progress achieved in carrying out the Program, in such detail as the Bank shall reasonably request; and (c) without limitation upon the provisions of paragraphs (a) and (b) of this Section, the Borrower shall promptly inform the Bank of any situation that would have the effect of materially reversing the objectives of the Program or any action taken under the Program including any action specified in Section I of Schedule 1 to this Agreement.

  • Bonus Program You will be eligible for an annual target bonus of 35% of your annual base salary as determined by the Board in its sole discretion based upon, among other things, the achievement of pre-determined performance milestones. Any annual bonus, if earned, shall be paid no later than March 15th of the year immediately following the year to which the applicable annual bonus relates.

  • Bonus Programs Employee may participate in any incentive program which may be made available from time to time to Corporation’s employees at Employee’s level; provided, however, that Employee’s participation is subject to the applicable terms, conditions and eligibility requirements of the program, as they may exist from time to time.

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