Participating Pharmacies. The PBM’s Participating Pharmacies are available to Enrollees who use medically necessary drugs Participating mail service pharmacies have toll free access to registered pharmacists to answer your questions. Participating specialty pharmacies have dedicated patient care coordinators to help You manage Your condition and offer toll-free twenty-four hour access to nurses and registered Pharmacists. You may obtain a list of the Participating Pharmacies, and Covered Drugs, by calling the Customer Service telephone number on the back of Your ID card, or review the lists on Our website at xxx.xxxxxxxxxxxxxxxxx.xxx. Covered Prescription Drug Benefits include the following. Prescription Legend Drugs. Injectable insulin and syringes used for administration of insulin. Oral contraceptive Drugs, injectable contraceptive drugs and patches are Covered when obtained through an eligible Pharmacy. If certain supplies, equipment or appliances are not obtained by Mail Service or from a Participating Pharmacy then they are Covered as Medical Supplies, Equipment and Appliances instead of under Prescription Drug benefits and may be subject to applicable DME Copays or Coinsurance. Injectables. Medical food that is Medically Necessary and prescribed by a Physician for the treatment of an inherited metabolic disease. Medical food means a formula that is intended for the dietary treatment of a disease or condition for which nutritional requirements are established by medical evaluation and formulated to be consumed or administered enterally under the direction of a Physician. Non-Covered Prescription Drug Benefits Prescription Drugs dispensed by any Mail Service program other than the PBM’s Mail Service, unless prohibited by law. Drugs, devices and products, or Prescription Legend Drugs with over the counter equivalents and any Drugs, devices or products that are therapeutically comparable to an over the counter Drug, device, or product. Off label use, except as otherwise prohibited by law or as approved by Us or the PBM. Drugs in quantities exceeding the quantity prescribed, or for any refill dispensed later than one year after the date of the original Prescription Order. Drugs not approved by the FDA. Charges for the administration of any Drug. Drugs consumed at the time and place where dispensed or where the Prescription Order is issued, including but not limited to samples provided by a Physician. This does not apply to Drugs used in conjunction with ...
Participating Pharmacies. Client shall not be eligible for rebates with respect to prescriptions under the Rebate Program if Participating Pharmacies are obligated or provided a financial incentive to follow or comply with a drug formulary other than the Formulary in connection with providing services for Participants of CarePlus.
Participating Pharmacies. The term “
Participating Pharmacies. ESI will maintain a network(s) of Participating Pharmacies as identified in Exhibit B, and will make available an updated list of Participating Pharmacies online. ESI maintains multiple networks and subnetworks, and periodically consolidates networks or migrates clients to other networks and subnetworks. If, due to an access concern, Sponsor requests that ESI attempt to add a particular retail pharmacy to the network of Participating Pharmacies serving Sponsor and its Members hereunder, ESI will make commercially reasonable efforts to add any such pharmacy to the Participating Pharmacy network for Sponsor, provided that such pharmacy meets ESI’s network participation requirements and agrees to ESI’s standard terms and conditions. If any such pharmacy meets ESI’s network participation requirements and agrees to ESI’s standard terms and conditions except for ESI’s standard network rates (i.e., the particular pharmacy will only agree to higher than standard reimbursement rates), and Sponsor nevertheless requests that ESI add such pharmacy, the rate charged to Sponsor for Prescription Drug Claims processed through such pharmacy (assuming ESI agrees to contract with such pharmacy) will be the net ingredient cost plus the dispensing fee paid by ESI to such Participating Pharmacy (plus applicable sales or excise tax or other governmental surcharge, if any). All such Prescription Drug Claims will be excluded from the pricing guarantees set forth in Exhibit B.
(i) ESI will require each Participating Pharmacy to meet ESI’s network participation requirements, including but not limited to licensure, insurance and provider agreement requirements. ESI also performs audits (i.e., electronic or on-site) of Participating Pharmacies to determine compliance with their provider agreement billing requirements. ESI re-credentials network providers on a rolling three (3) year schedule. ESI may re-credential or request additional credentialing more often than every three (3) years when ESI determines, in its sole discretion, that such credentialing or re-credentialing request is appropriate. ESI will attempt recovery of identified overpayments through offset, demand or other reasonable means; provided that ESI will not be required to institute litigation. Recovered overpayments are credited to Sponsor. The cost of conducting audits and audit-related services for ESI is included in the base administrative fee as set forth in Exhibit B, meaning that 100% of recoveries will be passe...
Participating Pharmacies. The amount paid to the Participating Pharmacy for Prescription Drug Claims may or may not be equal to the amount charged to Employer, and BlueCross will absorb any negative margin or retain any positive margin. Subject to applicable law, BlueCross may communicate with Members regarding benefit design, cost savings, availability and use of the selected networks, as well as provide supporting services. A list of Participating Pharmacies is available to Members on-line. BlueCross does not direct or exercise any control over the professional judgment exercised by any pharmacist providing pharmaceutical related services.
Participating Pharmacies. AdvancePCS has created a network of Participating Pharmacies, which will perform pharmacy services for Participants.
Participating Pharmacies. CastiaRx contracts, or arranges for contracts, with retail pharmacies to dispense prescription drugs to members. The rates paid by CastiaRx to these pharmacies differ from one network to another and among pharmacies. CastiaRx generally contracts with clients at a uniform rate that applies to all pharmacies in the selected network or may have a pass-through rate arrangement. Please review the PBM Agreement to determine the terms and conditions applicable to payments for retail pharmacy claims. Where the rate paid by a client exceeds the rate negotiated with a particular pharmacy, CastiaRx will realize a positive margin on the applicable prescription. The reverse may also be true, resulting in a negative margin. In addition, CastiaRx retains the benefit of the use of funds when CastiaRx receives payment from a client before paying the pharmacies. Pharmacy Dispensing and Distribution – One or more CastiaRx affiliates own and operate licensed pharmacies, including the CastiaRx Specialty Pharmacy and CastiaRx Mail Pharmacy. CastiaRx purchases prescription drug inventories, either directly from manufacturers or from drug wholesalers, for dispensing to patients or for distribution to Physician offices. Purchase discounts off of acquisition cost of these products are made available by manufacturers in the form of both up-front and retrospective discounts, and may include fees for certain services provided to manufacturers (e.g., Adverse Event reporting), and patients served through the CastiaRx Specialty Pharmacy. Such discounts are not considered part of the rebates paid to CastiaRx by manufacturers in connection with our rebate program. While rebates are directly attributable to the utilization of pharmaceutical products by individuals who receive benefits from clients for whom we provide PBM services, product acquisition price discounts are based on a pharmacy’s inventory needs and, in the case of specialty pharmacies, the performance of related patient care service obligations. The purchase discounts obtained by these facilities are not based on any client’s benefit design. When CastiaRx dispenses or distributes a product from its inventory or that of its retail pharmacy network, the purchase price paid for the dispensed product, including applicable dispensing fees, may be greater or less than the pharmacy’s acquisition cost for the product net of purchase discounts. In some circumstances, there may be a difference between what a client pays for a dispensed p...
Participating Pharmacies. Members who fill prescriptions at a non-participating pharmacy are responsible for payment at the time the prescription is filled. Members must submit claims to Anthem Blue Cross and Blue Shield for reimbursement, and payment will be sent to the member, Members who use non-participating pharmacies will pay 20% of the in-network allowance, plus the difference between Anthem Blue Cross and Blue Shield's payment and the pharmacist's actual charge. Limits and Exclusions Benefits are limited to no more than a 30-day supply for covered drugs purchased at a retail pharmacy, and no more than a 100-day supply for covered drugs purchased by mail service. All prescriptions are subject to the quantity limitations imposed by state and federal statutes. Benefits for prescription birth control and Sexual Dysfunction medications are optional for groups such as yours. Check with your benefits administrator to find out whether or not you have such benefits, Anthem. •V Lumerros Lumenos HSA Plan Summary The Lameness NSA plat is designed to empower you to take control are heath), as well as the dollars you spend on your health care, This pith gives you the Xxxxx-Xxxx would receive from a typical health plan, plus health care defiers to spend your way. Xxx you'll have access to personalized services and online tools to help you reach your health potential. First- Use your HSA to pay for covered services: Health Savings Account With the Lumenos Health Savings Account (RSA), you can contribute pre-tax dollars to your HSA account. Others may also contribute dollars to your account. You can use these dollars to help meet your annual deductible responsibility. Unused dollars can be saved or invested and accumulate through retirement Contributions to Your HSA For 2017, contributions can be made to your NSA up to the following: $3,400 individual coverage $6,750 tank coverage Nate: These xxxxx apply to all combined contributions from any source indudng HSA dollarsfrom Incentives. Earn More Money for Your Account What's special about your Lumenos HSA plan is that you may earn additional funds for your health account through the Healthy Rewards incentive program. To receive funds earned through the Heathy Rewards program, you must have an open HSA with Mellon Bank or with another bank through which your employer is sponsoring your HSA. Earn Rewards If you do this: • Fubre Moms for participation and completion • Healthy Lifestyles online ParlicPation • ConditionCamparticipation and comple...
Participating Pharmacies. Sponsor acknowledges and agrees that neither PBM, nor its shareholders, directors, officers or employees have any liability whatsoever to Sponsor or Members for the acts or omissions of any Participating Pharmacy (including, but not necessarily limited to, the acts or omissions of any Participating Pharmacy’s employees or agents) in connection with such Participating Pharmacy’s provision of services to Sponsor or Members, including, but not necessarily limited to, any of the following: (i) any actual or alleged malpractice, negligence or misconduct of any Participating Pharmacy; or (ii) the sale, compounding, dispensing, failure to sell, manufacture or use of any drug dispensed to a Member under this Agreement.
Participating Pharmacies. The Participating Pharmacy will submit a claim for Benefits directly to the PBM. Members will not need to submit a claim. Payment for Benefits – after applicable Cost-Sharing Amounts, if any - is made directly to that Participating Pharmacy.
