PBM Agreement Language Sample Clauses

PBM Agreement Language. 1. The following provisions shall be included in any agreement between the MCP and their PBM: 1. At least annually, the PBM shall hire an independent third party to complete a Service Organization Controls report (SOC-1) audit over the PBM’s services and activities. This report shall be provided to the MCP, and information from this audit shall be made available to ODM upon request. 2. The PBM shall not steer or require any providers or members to use a specific pharmacy in which the PBM has an ownership interest or that has an ownership interest in the PBM, if for the primary purpose of reducing competition or financially benefitting the PBM’s associated businesses. Arrangements between MCPs and PBMs to promote value- based reimbursement and purchasing or enhancing health outcomes are permitted. 3. The PBM shall load eligibility information into their system within 24 hours of receipt of the 834C file from the MCP. 4. The PBM shall report semi-annually to the MCP their list of specialty drugs by National Drug Code, including a report on any drugs that have moved between specialty and non-specialty designation. 5. The PBM shall submit a report containing data from the prior calendar year to the MCP. The report shall be made available to ODM upon request and contain the following information: i. The aggregate amount of all rebates that the PBM negotiated from all pharmaceutical manufacturers on behalf of the MCP; and ii. The aggregate administrative fees that the PBM negotiated from all pharmaceutical manufacturers on behalf of the MCP. 2. The following provisions shall be addressed in any agreement between the MCP and their PBM: a. The ability for the MCP, or its designee that has no ownership or control interest with the PBM, to audit and review contracts or agreements between the PBM and their pharmacies at least annually to ensure correct pricing has been applied. This includes, but is not limited to, prescription drug claim data, billing records, and other records to ensure the PBM’s compliance with the terms and conditions of their agreement. b. If there is not a provision in the agreement to restrict the PBM from selling pharmacy data, the MCP shall require a secure process to be included and followed. If any Ohio Medicaid MCP pharmacy data is sold, aggregate total amount received by the PBM for the MCP’s data shall be reported to the MCP at least semi-annually. c. The ability for the MCP, at its discretion, to enter into non-exclusive specialty phar...
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PBM Agreement Language. 1. The following provisions shall be included in any agreement between the MCP and their PBM: a. At least annually, the PBM shall hire an independent third party to complete a Service Organization Controls report (SOC-1) audit over the PBM’s services and activities. This report shall be provided to the MCP, and information from this audit shall be made available to ODM upon request. b. In addition to the SOC-1 audits, the PBM and the MCP shall cooperate with and grant full access to any independent audit entity retained by ODM to perform periodic compliance audits of each PBM. These compliance audits would measure the PBMs’ compliance with any 1 Rebates include manufacturer fees and administration fees for rebating.

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