Pharmacy Benefit Management Services Sample Clauses

Pharmacy Benefit Management Services. A. Services to be provided by the PBM (1) The PBM shall perform pharmacy services for Members through its network of participatingpharmacies. (2) The PBM shall adjudicate claims for pharmacy expenses covered under the Plan submitted by participating pharmacies using the PBM's electronic online claim adjudication system. The PBM's claim adjudication system will include all Plan information regarding deductibles, copayments, coinsurance, Member out-of-pocket maximums, benefit maximums, and any other features of the Plan to be used in processing claims. Participating pharmacies may collect from Members at the point of sale the amount specified in the Plan. The PBM shall reimburse participating pharmacies for such claims according to the terms of the PBM's Agreement with the participating pharmacy. (3) The PBM reserves the right to revise the drug formulary at any time and without prior notice.

Pharmacy Benefit Management Services. We will determine which pharmacies will be Network Pharmacies. The particular pharmacies that are Network Pharmacies can change at any time. We will make reasonable efforts to provide you with advance notice of any material changes in the network of Network Pharmacies.

Pharmacy Benefit Management Services. In this provision a Preferred Pharmacy shall mean a pharmacy which has entered into an agreement with UHS or its affiliate or subcontractor to provide prescription drug services to Covered Persons. UHS will determine which pharmacies will be Preferred Pharmacies. The particular pharmacies that are Preferred Pharmacies can change at any time. UHS will make reasonable efforts to provide City with advance notice of any material changes in the network of Preferred Pharmacies. If UHS furnishes a preferred drug list, also known as a drug formulary, for use with the Plan, City agrees not to copy, distribute, sell, or otherwise provide the preferred drug list to another party without UHS prior written approval, except to Covered Persons as described below. On termination of this Agreement, City will cease all use of the preferred drug list. UHS will process the claims of Preferred Pharmacies in accordance with the Description of Benefits and the Preferred Pharmacy’s participation agreement.

Pharmacy Benefit Management Services. In this provision a Preferred Pharmacy shall mean a pharmacy which has entered into an agreement with UHS or its affiliate or subcontractor to provide prescription drug services to Covered Persons. UHS will determine which pharmacies will be Preferred Pharmacies. The particular pharmacies that are Preferred Pharmacies can change at any time. UHS will make reasonable efforts to provide City with advance notice of any material changes in the network of Preferred Pharmacies. If UHS furnishes a preferred drug list, also known as a drug formulary, for use with the Plan, City agrees not to copy, distribute, sell, or otherwise provide the preferred drug list to another party without UHS prior written approval, except to Covered Persons as described below. On termination of this Agreement, City will cease all use of the preferred drug list. UHS will process the claims of Preferred Pharmacies in accordance with the Description of Benefits and the Preferred Pharmacy’s participation agreement. (1) City agrees to use the UHS preferred drug list and pharmacy network; (2) City agrees to distribute or permit UHS to distribute the preferred drug list to Covered Persons; (3) City agrees to conduct appropriate communication with the Covered Persons, i.e., advising Covered Persons to furnish a copy of the preferred drug list to their physicians; (4) City agrees to other reasonable requirements for participation in the preferred drug list rebate program that UHS may communicate to City from time to time. Income to Subcontractor from Drug Manufacturers. UHS’ subcontractor provides to drug manufacturers certain administrative services, formulary compliance services, computer software, non-confidential data, and/or research services and is paid by the manufacturer for such services, software and non-confidential data. UHS does not receive, or share in, these amounts.

Pharmacy Benefit Management Services. A fully transparent PBM service that focuses on eliminating spread. Participating Programs • Pure pass-through pricing from pharmacies PBM Services Member Services Clinical Services Rebate Services Network Mgmt. Billing & Payment Reporting Analytics • 100% pass-through of all manufacturer rebates and fees • Full audit rights • Annual market checks Information is confidential and proprietary and may not be reproduced unless authorized in writing by a representative of the Northwest Prescription Drug Consortium or Moda Health. Xxxx Xxx Subscriber Xxxx Xxx xxxxxxxxxx.xxx ID number MXXXXXXXX Pharmacy Wholesaler Manufacturer • Purchases are not subsidized by state funds • Offers individual consumers pricing comparable to participating groups under the NW Consortium • Over 55,000 pharmacies participate nationwide Information is confidential and proprietary and may not be reproduced unless authorized in writing by a representative of the Northwest Prescription Drug Consortium or Moda Health. Manufacturer B <.. image(A picture containing drawing Description automatically generated) removed ..> • Services provided via a national organization GPO Program Facilities Corrections State Hospitals Public programs • Deliver aggressive class of trade pricing for public entities • Regular market checks to ensure competitiveness • No affiliation fee for government programs Information is confidential and proprietary and may not be reproduced unless authorized in writing by a representative of the Northwest Prescription Drug Consortium or Moda Health. Rx Voucher • Prescription drug service for individuals upon discharge or for emergent need use on site Pharmacy + • One time access to prescription at retail pharmacy • Paid for by discharging institution • Significant savings over pharmacy usual & customary price Information is confidential and proprietary and may not be reproduced unless authorized in writing by a representative of the Northwest Prescription Drug Consortium or Moda Health.

Pharmacy Benefit Management Services. Pharmacy Benefit Services are provided with respect to covered prescription drugs that are provided as a preventive care benefit.

Pharmacy Benefit Management Services. UPMC agrees to make available to Evolent and Evolent Clients, the Pharmacy Benefit Management Services (“PBM Services”) as set forth on Schedule 1, subject to the restrictions and pricing set forth therein. The Parties expressly understand and agree that the services and pricing on Schedule 1 are effective through December 31, 2014. Evolent must provide notice to UPMC on or before February 1, 2014 (the “Notice Date”) of Evolent’s or any Evolent Client’s desire not to utilize UPMC for PBM Services. All Evolent Clients electing to receive PBM Services after the Notice Date must agree to minimum three-year terms with respect to those PBM Services.

Pharmacy Benefit Management Services