Outpatient Pharmacy Services Sample Clauses

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.
Sample 1
AutoNDA by SimpleDocs
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.
Sample 1
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.
Sample 1
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. 1. Requests for reimbursement of pharmaceutical drugs not listed on the VA formulary shall be submitted by the THP for approval by the local VAMC Pharmacy in advance of the request for reimbursement to the VA If the THP received approval for reimbursement for a VA Non-Formulary pharmaceutical, the IHS must attach the approval documentation with the submitted pharmacy claims
Sample 1
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. a. VA will not separately reimburse THP for pharmaceuticals and biologicals that are already reimbursed through VA’s payment of the THP’s all-inclusive rate (AIR).
Sample 1
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
Sample 1
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.
Sample 1
AutoNDA by SimpleDocs
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.
Sample 1

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.

  • Outpatient Services Physicians, Urgent Care Centers and other Outpatient Providers located outside the BlueCard® service area will typically require You to pay in full at the time of service. You must submit a Claim to obtain reimbursement for Covered Services.

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.

  • Inpatient Services Hospital Rehabilitation Facility

  • Radiation Therapy/Chemotherapy Services This plan covers chemotherapy and radiation services. This plan covers respiratory therapy services. When respiratory services are provided in your home, as part of a home care program, durable medical equipment, supplies, and oxygen are covered as a durable medical equipment service.

  • 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 or non- 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 or non-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.

  • Outpatient If you receive infusion therapy services in a hospital's outpatient unit, we cover the use of the treatment room, related supplies, and solutions. For prescription drug coverage, see Section 3.27

  • Anesthesia Services This plan covers general and local anesthesia services received from an anesthesiologist when the surgical procedure is a covered healthcare service. This plan covers office visits or office consultations with an anesthesiologist when provided prior to a scheduled covered surgical procedure.

  • Medical Services We do not Cover medical services or dental services that are medical in nature, including any Hospital charges or prescription drug charges.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!