Common use of Outpatient Pharmacy Clause in Contracts

Outpatient Pharmacy. Simple or compound substances prescribed for the cure, mitigation, or prevention of disease or for health maintenance (e.g., prescription drugs, family planning supplies, vitamins for children to age twenty-one (21), and prenatal vitamins) are covered by fee-for-service Medicaid. Hemophilia-related clotting factor drugs, Spinraza, other drugs deemed by DHHR as appropriate for fee-for-service coverage, and Hepatitis-C virus-related drugs will be covered by fee-for- service Medicaid. Drugs and supplies dispensed by a physician, acquired by the physician at no cost, are not covered by Medicaid. The Department will provide the MCO with pharmacy utilization data to support coordination of care for the member. The MCO remains responsible for all physician-administered drugs, such as those provided as part of an inpatient stay, a bundled ER visit, or administered vaccinations.

Outpatient Pharmacy. Simple or compound substances prescribed for the cure, mitigation, or prevention of disease or for health maintenance (e.g., prescription drugs, family planning supplies, vitamins for children to age twenty-one (21), and prenatal vitamins) are covered by fee-for-service FFS Medicaid. Hemophilia-related clotting factor drugs, Spinraza, other drugs deemed by DHHR as appropriate for fee-for-service FFS coverage, and Hepatitis-C virus-related drugs will be covered by fee-for- service FFS Medicaid. Drugs and supplies dispensed by a physician, acquired by the physician at no cost, are not covered by Medicaid. The Department will provide the MCO with pharmacy utilization data to support coordination of care for the memberenrollee. The MCO remains responsible for all physicianother provider-administered drugs, such as those provided as part of an inpatient stay, a bundled ER visit, or administered vaccinations.

Outpatient Pharmacy. Simple or compound substances prescribed for the cure, mitigation, or prevention of disease or for health maintenance (e.g., prescription drugs, family planning supplies, vitamins for children to age twenty-one (21), and prenatal vitamins) are covered by fee-for-service Medicaid. Hemophilia-related clotting factor drugs, Spinraza, other drugs deemed by DHHR BMS as appropriate for fee-for-service coverage, and Hepatitis-C virus-related drugs will be covered by fee-for- for-service Medicaid. Drugs and supplies dispensed by a physician, acquired by the physician at no cost, are not covered by Medicaid. The Department will provide the MCO with pharmacy utilization data to support coordination of care for the member. The MCO remains responsible for all physician-administered drugs, such as those provided as part of an inpatient stay, a bundled ER visit, or administered vaccinations.