Common use of PAYMENT FOR HIV/AIDS DRUGS Clause in Contracts

PAYMENT FOR HIV/AIDS DRUGS. The contractor shall be paid separately for protease inhibitors and other anti-retroviral agents (First Data Bank Specific Therapeutic Class Codes W5C, W5B, W5I, W5J, W5K, W5L, W5M, W5N) for all eligibility groups, Payment for protease inhibitors shall be made by DMAHS to the contractor based on: 1) submission of appropriate encounter data; and 2) notification from the contractor to DMAHS within 12 months of the date of service of identification of individuals with HIV/AIDS. Payment for these products will be the lesser of: 1) Average Wholesale Price (AWP) minus 12.5% and 2) rates paid by the contractor. Individuals eligible through NJ FamilyCare with a program status code of 380 and all children groups shall receive protease inhibitors and other anti-retroviral agents under the contractor's plan. All other individuals eligible through NJ FamilyCare with program status codes of 497-498, 300-301, 700-701, and 763 shall receive protease inhibitors and other anti-retrovirals (First Data Bank Specific Therapeutic Class Codes W5C, X0X, X00, X0X, X0X, X0X, X0X and W5N) through Medicaid fee for service and/or the AIDS Drug Distribution Program (ADDP).

PAYMENT FOR HIV/AIDS DRUGS. The contractor shall be paid separately for protease inhibitors and other anti-retroviral agents (First Data Bank Specific Therapeutic Class Codes W5C, W5B, W5I, W5J, W5K, W5LW0X, W5MX0X, W5N) for all eligibility groups, X0X). Payment for protease inhibitors shall be made by DMAHS to the contractor based on: 1) submission on 1)submission of appropriate encounter data; and 2) notification from the contractor to DMAHS within 12 months of the date of service of identification of individuals with HIV/AIDS. Payment for these products will be the lesser of: 1) Average of 1)Average Wholesale Price (AWP) minus 12.5% and 2) rates paid by the contractor. Individuals eligible through NJ FamilyCare Plans A, B, C and only those Plan D enrollees with a program status code of 380 and all children groups shall receive protease inhibitors and other anti-retroviral agents under the contractor's ’s plan. All other individuals individual eligible through NJ FamilyCare P with program status codes of 497-498, 300-301, 700-701, and 763 763, and all Plan H individuals shall receive protease inhibitors and other anti-retrovirals (First Data Date Bank Specific Therapeutic Class Codes W5C, X0XW5B, X00W5I, X0XW5J, X0XW5K, X0XW5L, X0X W5M, and W5N) through Medicaid fee for service and/or the AIDS Drug Distribution Program (ADDP).

PAYMENT FOR HIV/AIDS DRUGS. The contractor shall be paid separately for protease inhibitors and other anti-retroviral agents (First Data Bank Specific Therapeutic Class Codes W5C, W5B, W5I, W5JWSJ, W5K, W5L, W5M, W5N) for all eligibility groups, ). Payment for protease inhibitors shall be made by DMAHS to the contractor based on: 1) submission of appropriate encounter data; and 2) notification from the contractor to DMAHS within 12 months of the date of service of identification of individuals with HIV/AIDS. Payment for these products will be the lesser of: 1) Average Wholesale Price (AWP) minus 12.5% and 2) rates paid by the contractor. Individuals eligible through NJ FamilyCare with a program status code of 380 and all children groups shall receive protease inhibitors and other anti-retroviral agents under the contractor's plan. All other individuals eligible through NJ FamilyCare with program status codes of 497-498, 300-301, 700-701, and 763 shall receive protease inhibitors and other anti-retrovirals (First Data Bank Specific Therapeutic Class Codes W5C, X0XW5B, X00W5I, X0XW5J, X0XW5K, X0XW5L, X0X W5M and W5N) through Medicaid fee for service and/or the AIDS Drug Distribution Program (ADDP).

PAYMENT FOR HIV/AIDS DRUGS. The contractor shall be paid separately for protease inhibitors and other anti-retroviral agents (First Data Bank Specific Therapeutic Class Codes W5C, W5B, W5I, W5JWSJ, W5K, W5L, W5M, W5N) for all eligibility groups, . Payment for protease inhibitors shall be made by DMAHS to the contractor based on: 1) submission of appropriate encounter data; and 2) notification from the contractor to DMAHS within 12 months of the date of service of identification of individuals with HIV/AIDS. Payment for these products will be the lesser of: 1) Average Wholesale Price (AWP) minus 12.5% and 2) rates paid by the contractor. Individuals eligible through NJ FamilyCare with a program status code of 380 and all children groups shall receive protease inhibitors and other anti-retroviral agents under the contractor's plan. All other individuals eligible through NJ FamilyCare with program status codes of 497-498, 300-301, 700-701, [Reserved] and 763 shall receive protease inhibitors and other anti-retrovirals [Reserved] (First Data Bank Specific Therapeutic Class Codes W5C, X0XW5B, X00W51, X0XW5J, X0XW5K, X0XW5L, X0X W5M and W5N) through Medicaid fee for service and/or the AIDS xxx xxxxxxx xxx/xx xxx XXXX Drug Distribution Program (ADDP).