Mail Order Pharmacy. You have a choice of obtaining certain Prescription Drugs/Medications directly from a Pharmacy or by ordering them through the mail. Under the mail order pharmacy benefit, Preferred and non- Preferred medications can be obtained through the Mail Order Service Pharmacy. You may purchase up to a 90-day supply up to the maximum dosing recommended by the manufacturer. You may obtain more information on the Mail Service Pharmacy by calling our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday, from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711. • Cost Sharing Copayments at the applicable Tier Copayment. • Certain drugs may not be purchased by mail order, such as Self-Administered Specialty Pharmaceuticals.
Mail Order Pharmacy. You have a choice of obtaining certain Prescription Drugs/Medications directly from a Pharmacy or by ordering them through the mail. Under the mail order pharmacy benefit, Preferred and non- Preferred medications can be obtained through the Mail Order Service Pharmacy. You may purchase up to a 90-day supply up to the maximum dosing recommended by the manufacturer. Cost Sharing Copayments apply at the applicable Tier Copayment and certain drugs may not be purchased by mail order, such as Self-Administered Specialty Pharmaceuticals. You may obtain more information on the Mail Service Pharmacy by calling our Presbyterian Customer Service Center at (000) 000-0000 or 0-000-000-0000, Monday through Friday from 7 a.m. to 6 p.m. Hearing impaired users may call TTY 711.
Mail Order Pharmacy an establishment that is registered or licensed in the state in which it is domiciled, from which Prescription Drugs are dispensed by a Pharmacist, which has entered into a written agreement to provide Prescription Drugs to Insureds of the Company who are eligible under this Program, and which has been separately identified to Insureds in a directory or through some other means. The Mail Order Pharmacy, after receiving and processing Your Prescription Order, will deliver the Prescription Drugs through a parcel delivery service company.
Mail Order Pharmacy. This is an establishment where prescription drugs are legally dispensed by mail. Health care or dental services, and supplies or prescription drugs that a physician, other health care provider or dental provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an sickness or injury or its symptoms, and that provision of the service, supply or prescription drug is: • In accordance with generally accepted standards of medical or dental practice; • Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient’s sickness or injury; • Not primarily for the convenience of the patient, physician, or other health care or dental provider; and • Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s sickness or injury. For these purposes “generally accepted standards of medical or dental practice” means standards that are based on credible scientific evidence published in peer-reviewed literature generally recognized by the relevant medical or dental community, or otherwise consistent with physician or dental specialty society recommendations and the views of physicians or dentists practicing in relevant clinical areas and any other relevant factors. These are health care services that Aetna determines that a provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating sickness, injury, disease or its symptoms, and that Aetna determines are: • In accordance with generally accepted standards of medical practice; • Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient’s sickness, injury or disease; • Not primarily for the convenience of the patient, physician, or other health care provider; and • Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s sickness, injury or disease. Generally accepted standards of medical practice means: • Standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community; and • Consistent wit...
Mail Order Pharmacy. 4.13.1 The PBM shall maintain, and provide WellPoint’s Plan access to the mail service pharmacy(s) network to provide Covered Prescriptions to Covered Individuals through the United States Postal Service or private shipping enterprises.
4.13.2 Nothing in the Agreement or this Part D Exhibit shall prohibit the PBM from utilizing or contracting with third-party mail service pharmacies to provide Covered Prescriptions to Covered Individuals. The rates applicable to the Pharmacies participating in the Mail Order Pharmacy network shall be consistent with the rates set forth in Exhibit A. Collectively, the PBM’s owned or affiliated mail order Pharmacies and other third-party mail order Pharmacies shall be referred to as “Mail Order Pharmacy.”
4.13.3 Mail Order Pharmacy shall receive prescriptions from Covered Individuals via the U.S. mail or commercial carrier at an address specified by each Mail Order Pharmacy from time to time. Subject to reasonable processing parameters, Mail Order Pharmacy or its designee shall dispense drugs covered by the Plan in accordance with such prescriptions, and mail the Covered Prescriptions to Covered Individuals at addresses designated by such Covered Individuals, so long as such addresses are located in the United States or Puerto Rico.
4.13.4 Mail Order Pharmacy and its designees shall dispense Covered Prescriptions according to applicable state and federal law and in accordance with standards of care prevalent in the mail service pharmacy industry. Mail Order Pharmacy shall have no obligation to fill any prescription for Covered Prescriptions, which is not accompanied by an appropriately completed order form and the payment of any applicable Co-payment, Co-insurance or Deductible. The PBM shall implement applicable measures to help ensure Mail Order Pharmacies implement appropriate monitoring and quality control measures in an effort to promote accurate and timely dispensing and communication of patient specific information. The PBM shall ensure that Mail Order Pharmacies provide a professional pharmacist staff to evaluate the appropriateness of prescriptions to the extent required by standard pharmacy practice and laws.
4.13.5 Mail Order Pharmacy shall provide to Covered Individuals toll-free telephone access to pharmacists and service representatives.
4.13.6 Claims submitted by Covered Individuals through Mail Order Pharmacy or its designee shall be processed in a manner similar to the manner in which retail Claims are proce...
Mail Order Pharmacy. The Contractor shall accept prescription orders at TMOP by written (original or facsimile), electronic (supporting digital signature including e-prescribing), or telephonic submission. The
Mail Order Pharmacy. A Network Pharmacy that provides Covered Prescription Services to Members via mailing or shipping utilizing the United States Postal Service and/or other common shipping carrier, including FedEx and/or United Parcel Service.
Mail Order Pharmacy. Contractor agrees that although they may offer mail order pharmacy as an option to beneficiaries, they or their PBM are not allowed to require or incentivize the use of Mail Order Pharmacy.
Mail Order Pharmacy. The term “
Mail Order Pharmacy. The prescription drug coverage for mail order drugs will be as follows for up to a 90-day supply: • The copay for generic drugs will be the DNP for the original prescription and each refill, with a maximum copay of $16 for each of 2013 and 2014, and $18 for 2015. • The copay for single-source and multi-source brand name drugs will be 30% of the DNP for the original prescription and each refill, with a maximum copay of $50 for each of 2013 and 2014, and for 2015 and each calendar year thereafter, the maximum copay will increase by 6% when compared with the maximum copay for the prior Plan Year. • If an associate purchases a brand name drug when a generic equivalent is available, the associate will pay an amount equal to (a) the DNP, up to a maximum of $16 for each of 2013 and 2014, or $18 for 2015, plus (b) 100% of the cost difference between the brand name and generic drug, and the fixed dollar maximum copays described above will not apply. If the associate’s treating physician certifies that the associate is medically unable to take the generic medication and such exception is approved by the TPA’s procedures for approval of treatment or services, then the single source and multi-source coverage will apply.
