Common use of OUTPATIENT PRESCRIPTION DRUG EXPENSE Clause in Contracts

OUTPATIENT PRESCRIPTION DRUG EXPENSE. 10.01 Calculating PARTICIPATING MEDICAL GROUP PMPM Outpatient Prescription Drug Expenses (“PMPM OPDE”). The Outpatient Prescription Drug Expense (“OPDE”) shall include expenses incurred by BLUE CROSS to provide covered outpatient prescription drugs to Members assigned to PARTICIPATING MEDICAL GROUP. BLUE CROSS shall accrue OPDE for each PARTICIPATING MEDICAL GROUP by the calendar year the services were incurred and paid through one hundred and twenty (120) days after year-end. Beginning in year two (2) of this Agreement, any claims received after calculation of the final Outpatient Prescription Drug Settlement will be charged to the following year’s OPDE. Notwithstanding the aforementioned, any claims for outpatient prescription drug services incurred prior to 1997 but paid after the final Non-Capitated Performance Settlement calculation for 1996 and if applicable, for subsequent years, will be charged to the following year’s OPDE. PARTICIPATING MEDICAL GROUP’s PMPM OPDE is the quotient of PARTICIPATING MEDICAL GROUP’s OPDE divided by the PARTICIPATING MEDICAL GROUP’s calendar year Member Months for Members with outpatient prescription drug benefits. BLUE CROSS shall provide PARTICIPATING MEDICAL GROUP with quarterly reports advising them of their OPDE. Report formats are described in the Operations Manual.

OUTPATIENT PRESCRIPTION DRUG EXPENSE. 10.01 Calculating PARTICIPATING MEDICAL GROUP PMPM Outpatient Prescription Drug Expenses (“PMPM OPDE”). The Outpatient Prescription Drug Expense (“OPDE”) shall include expenses incurred by BLUE CROSS to provide covered outpatient prescription drugs to Members assigned to PARTICIPATING MEDICAL GROUP. BLUE CROSS shall accrue OPDE for each PARTICIPATING MEDICAL GROUP by the calendar year the services were incurred and paid through one hundred and twenty (120) days after year-end. end Beginning in year two (2) of this Agreement, any claims received after calculation of the final Outpatient Prescription Drug Settlement will be charged to the following year’s OPDE. Notwithstanding the aforementioned, any claims for outpatient prescription drug services incurred prior to 1997 but paid after the final Non-Capitated Performance Settlement calculation for 1996 and if applicable, for subsequent years, will be charged to the following year’s OPDE. PARTICIPATING MEDICAL GROUP’s PMPM OPDE is the quotient of PARTICIPATING MEDICAL GROUP’s OPDE divided by the PARTICIPATING MEDICAL GROUP’s calendar year Member Months for Members with outpatient prescription drug benefits. BLUE CROSS shall provide PARTICIPATING MEDICAL GROUP with quarterly reports advising them of their OPDE. Report formats are described in the Operations Manual.

OUTPATIENT PRESCRIPTION DRUG EXPENSE. 10.01 Calculating PARTICIPATING MEDICAL GROUP PMPM Outpatient Prescription Drug Expenses (“PMPM OPDE”). The Outpatient Prescription Drug Expense (“OPDE”) shall include expenses incurred only those amounts paid by BLUE CROSS to pharmacies or pharmacists to provide covered outpatient prescription drugs to Members assigned to PARTICIPATING MEDICAL GROUP. Any rebates or other similar arrangements between BLUE CROSS and manufacturers/vendors shall not be considered in determining the Outpatient Prescription Drug Expense Target, the OPDE, or the Outpatient Prescription Drug Settlement. BLUE CROSS shall accrue OPDE for each PARTICIPATING MEDICAL GROUP by the calendar year the services were incurred and paid through one hundred and twenty (120) days after year-end. Beginning in year two (2) of this Agreement, any claims received after calculation of the final Outpatient Prescription Drug Settlement will be charged to the following year’s OPDE. Notwithstanding the aforementioned, any claims for outpatient prescription drug services incurred prior to 1997 but the Initial Term of this Agreement paid after the final Non-Capitated Performance Settlement calculation for 1996 April 30th immediately following the effective date hereof and if applicable, for subsequent years, will be charged to the following year’s OPDE. PARTICIPATING MEDICAL GROUP’s PMPM OPDE is for the quotient of PARTICIPATING MEDICAL GROUP’s OPDE divided by the PARTICIPATING MEDICAL GROUP’s first calendar year Member Months for Members with outpatient prescription drug benefits. BLUE CROSS shall provide PARTICIPATING MEDICAL GROUP with quarterly reports advising them of their OPDE. Report formats are described in the Operations Manual.this Agreement, or portion thereof