Outpatient Pharmacy Services Sample Clauses

Outpatient Pharmacy Services. VA shall reimburse actual cost of the drugs for outpatient emergent need prescriptions or other outpatient prescriptions to AI/AN Eligible Veterans to initialize or continue therapy before VA Consolidated Mail Outpatient Pharmacy (CMOP) can provide. VA reimbursement shall be limited to not more than a 30-day supply.
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Outpatient Pharmacy Services. VA will reimburse for outpatient medications on the IHS formulary associated with the provision of Direct Care Services provided to an Eligible AI/AN Veteran.
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Outpatient Pharmacy Services. VA shall reimburse the IHS at the IHS’s reasonable billed charges. VA Payment Operations will complete audits on the Outpatient Pharmacy and reserves the right to request the IHS Formulary information from the IHS.
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Outpatient Pharmacy Services. VA shall reimburse actual cost of the drugs for outpatient emergent need prescriptions or other outpatient prescriptions to Eligible AI/AN Veterans to initialize or continue therapy before prescriptions can be provided through the VA Consolidated Mail Outpatient Pharmacy (CMOP). In those instances, VA reimbursement shall be limited to not more than a 30-day supply. Referral to CMOP. VA will provide THP with information about how to make referrals to VA CMOP for Eligible AI/AN Veterans so they may obtain their prescriptions through the VA CMOP for the supply of medications after the 30 day supply.
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Outpatient Pharmacy Services. VA shall reimburse the THP for outpatient medications on the THP formulary when associated with the provision of Direct Care Services provided to an Eligible American Indian/Alaska Native Veteran. VA will not reimburse for the following: (1) compounded medications; (2) medications that are not approved by the Food and Drug Administration (FDA); (3) medications that are considered experimental.
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Outpatient Pharmacy Services. VA shall reimburse the THP for Outpatient Pharmacy Services at the lesser of reasonable billed charges or the Wholesale Acquisition Cost (WAC) plus a $3.50 dispensing fee per pharmaceutical (not including supplies). VA Payment Operations will complete audits on the Outpatient Pharmacy and reserves the right to request the THP Formulary information from the THP.
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Outpatient Pharmacy Services. VA shall reimburse the THP only for pharmaceutical drugs listed on the formulary used by VA in accordance with National VHA policy and applicable Veterans Integrated Service Network (VISN) and local VA Medical Center (VAMC) policy for medication orders. The Pharmacy Benefits Management Services (xxxx://xxx.xxx.xx.xxx/xxxxxxxxxxxxxxxxx.xxx ) webpage contains the VA National Formulary.
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Outpatient Pharmacy Services. To the extent pharmaceuticals are reimbursable under this Agreement, VA shall reimburse the THP as follows: VA shall pay at the lesser of billed charges or Wholesale Acquisition Cost (WAC), updated monthly, plus a $2 dispensing fee per outpatient pharmaceutical. Dispensing fee will increase to $3 effective 1/1/2028. If there is not WAC rate, VA will reimburse based on the lowest price government cost report or billed charges, whichever is lower. VA’s current vendor for WAC is MediSpan but is subject to change.
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Related to Outpatient Pharmacy Services

  • Pharmacy Services The Contractor shall establish a network of pharmacies. The Contractor or its PBM must provide at least two (2) pharmacy providers within thirty (30) miles or thirty (30) minutes from a member’s residence in each county, as well as at least two (2) durable medical equipment providers in each county or contiguous county.

  • Inpatient Services Hospital This plan covers services provided while inpatient in a general or specialty hospital including, but not limited to the following: • anesthesia; • diagnostic tests and lab services; • dialysis; • drugs; • intensive care/coronary care; • nursing care; • physical, occupational, speech and respiratory therapies; • physician’s services while hospitalized; • radiation therapy; • surgery related services; and • room and board. Notify us if you are admitted from the emergency room to a hospital that is not in our network. Our Customer Service Department can assist you with any questions you may have about your coverage. Rehabilitation Facility This plan covers rehabilitation services received in a general hospital or specialty hospital. Coverage is limited to the number of days shown in the Summary of Medical Benefits.

  • Paramedical Services Services of the following registered/certified practitioners up to the maximums shown on the "Summary of Benefits" pages:

  • Chiropractic Services This plan covers chiropractic visits up to the benefit limit shown in the Summary of Medical Benefits. The benefit limit applies to any visit for the purposes of chiropractic treatment or diagnosis.

  • Telemedicine Services This plan covers clinically appropriate telemedicine services when the service is provided via remote access through an on-line service or other interactive audio and video telecommunications system in accordance with R.I. General Law § 27-81-1. Clinically appropriate telemedicine services may be obtained from a network provider, and from our designated telemedicine service provider. When you seek telemedicine services from our designated telemedicine service provider, the amount you pay is listed in the Summary of Medical Benefits. When you receive a covered healthcare service from a network provider via remote access, the amount you pay depends on the covered healthcare service you receive, as indicated in the Summary of Medical Benefits. For information about telemedicine services, our designated telemedicine service provider, and how to access telemedicine services, please visit our website or contact our Customer Service Department.

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