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

  • Inpatient Services Hospital Rehabilitation Facility

  • Administration Services When a medical prescription drug is administered by infusion, the administration of the prescription drug may be covered separately from the prescription drug. See Infusion Therapy - Administration Services in the Summary of Medical Benefits for benefit limits and the amount you pay. Prescription drugs that are self-administered are not covered as a medical benefit but may be covered as a pharmacy benefit. Please see Pharmacy Prescription Drugs and Diabetic Equipment or Supplies – Pharmacy Benefits section above for additional information. For some medical prescription drugs, after the first administration, coverage may be limited to certain locations (for example, a designated outpatient or ambulatory service facility, physician’s office, or your home), provided the location is appropriate based on your medical status. For a list of medical prescription drugs that are subject to this Site of Care Program, visit our website. Preauthorization may be required to determine medical necessity as well as appropriate site of care. If we deny your request for preauthorization, or you disagree with our determination for the appropriate site of care, you can submit a medical appeal. See Appeals in Section 5 for information on how to file a medical appeal.

  • Outpatient Services Physicians, Urgent Care Centers and other Outpatient Providers located outside the BlueCard® service area will typically require You to pay in full at the time of service. You must submit a Claim to obtain reimbursement for Covered Services.

  • Administrative Services In addition to the portfolio management services specified above in section 2, you shall furnish at your expense for the use of the Fund such office space and facilities in the United States as the Fund may require for its reasonable needs, and you (or one or more of your affiliates designated by you) shall render to the Trust administrative services on behalf of the Fund necessary for operating as an open end investment company and not provided by persons not parties to this Agreement including, but not limited to, preparing reports to and meeting materials for the Trust's Board of Trustees and reports and notices to Fund shareholders; supervising, negotiating contractual arrangements with, to the extent appropriate, and monitoring the performance of, accounting agents, custodians, depositories, transfer agents and pricing agents, accountants, attorneys, printers, underwriters, brokers and dealers, insurers and other persons in any capacity deemed to be necessary or desirable to Fund operations; preparing and making filings with the Securities and Exchange Commission (the "SEC") and other regulatory and self-regulatory organizations, including, but not limited to, preliminary and definitive proxy materials, post-effective amendments to the Registration Statement, semi-annual reports on Form N-SAR and notices pursuant to Rule 24f-2 under the 1940 Act; overseeing the tabulation of proxies by the Fund's transfer agent; assisting in the preparation and filing of the Fund's federal, state and local tax returns; preparing and filing the Fund's federal excise tax return pursuant to Section 4982 of the Code; providing assistance with investor and public relations matters; monitoring the valuation of portfolio securities and the calculation of net asset value; monitoring the registration of Shares of the Fund under applicable federal and state securities laws; maintaining or causing to be maintained for the Fund all books, records and reports and any other information required under the 1940 Act, to the extent that such books, records and reports and other information are not maintained by the Fund's custodian or other agents of the Fund; assisting in establishing the accounting policies of the Fund; assisting in the resolution of accounting issues that may arise with respect to the Fund's operations and consulting with the Fund's independent accountants, legal counsel and the Fund's other agents as necessary in connection therewith; establishing and monitoring the Fund's operating expense budgets; reviewing the Fund's bills; processing the payment of bills that have been approved by an authorized person; assisting the Fund in determining the amount of dividends and distributions available to be paid by the Fund to its shareholders, preparing and arranging for the printing of dividend notices to shareholders, and providing the transfer and dividend paying agent, the custodian, and the accounting agent with such information as is required for such parties to effect the payment of dividends and distributions; and otherwise assisting the Trust as it may reasonably request in the conduct of the Fund's business, subject to the direction and control of the Trust's Board of Trustees. Nothing in this Agreement shall be deemed to shift to you or to diminish the obligations of any agent of the Fund or any other person not a party to this Agreement which is obligated to provide services to the Fund.

Most Referenced Clauses

Most Referenced Definitions