Pharmacy Benefit Manager. (PBM): an entity with which the Company contracts for the provision of administrative, utilization review and network services for the covered drug and supplies under this Program.
Pharmacy Benefit Manager. (PBM) The MCO must use a PBM to process prescription claims. The MCO must identify the proposed PBM and the ownership of the proposed PBM. If the PBM is owned wholly or in part by a retail pharmacy provider, chain drug store or pharmaceutical manufacturer, the MCO will submit a written description of the assurances and procedures that must be put in place under the proposed PBM Subcontract, such as an independent audit, to ensure no conflicts of interest exist and ensure the confidentiality of proprietary information. The MCO must provide a plan documenting how it will monitor these Subcontractors. These assurances and procedures must be submitted for HHSC's review during Readiness Review (see Section 7, "Transition Phase Requirements") then prior to initiating any PBM Subcontract after the Operational Start Date. The MCO must ensure its subcontracted PBM follows all pharmacy-related Contract, UMCM, state, and federal law requirements related to the provision of pharmacy services.
Pharmacy Benefit Manager. In the event that the Employer changes PBM’s, the Union and Management will work collaboratively concerning the selection of the PBM.
Pharmacy Benefit Manager. (PBM) The MCO must use a PBM to process prescription claims. The MCO must identify the proposed PBM and the ownership of the proposed PBM. If the PBM is owned wholly or in part by a retail pharmacy provider, chain drug store or pharmaceutical manufacturer, the MCO will submit a written description of the assurances and procedures that must be put in place under the proposed PBM Subcontract, such as an independent audit, to ensure no conflicts of interest exist and ensure the confidentiality of proprietary information. The MCO must provide a plan documenting how it will monitor these Subcontractors. These assurances and procedures must be submitted for HHSC's review during Readiness Review (see Section 7, "Transition Phase Requirements") then prior to initiating any PBM Subcontract after the Operational Start Date. The MCO must ensure its subcontracted PBM follows all pharmacy-related Contract, UMCM, state, and federal law requirements related to the provision of pharmacy services. Further, the MCO’s reimbursement methodology for the PBM must be based on the actual amount paid by the PBM to a pharmacy for dispensing and ingredient costs. However, this prohibition on the industry practice known as “spread pricing” is not intended to prohibit the MCO from paying the PBM reasonable administrative and transactional costs for services, as described in Uniform Managed Care Manual Chapter 6.1, “Cost Principles for Expenses.”
Pharmacy Benefit Manager. In the event that the employer changes PBM’s, the Union and Management will work collaboratively concerning the selection of the PBM. SWEDISH MEDICAL CENTER SEIU HEALTHCARE 1199NW, HOSPITAL AND HEALTH CARE EMPLOYEES UNION Xxx Xxxxxxx, M.D., Chief Executive Officer Xxxxx Xxxxx, RN, President Date Date MEMORANDUM OF AGREEMENT #1 Between SWEDISH MEDICAL CENTER and SEIU HEALTHCARE 1199NW APPLIES TO REGISTERED NURSES, SERVICE AND MAINTENANCE AND TECHNICAL UNITS
Pharmacy Benefit Manager. The Pharmacy Benefit Manager (PBM) that HNI uses for on-line reimbursement of pharmaceutical medications.
Pharmacy Benefit Manager i. Contractor agrees their contracted PBM will be directly available to State staff and oversight regarding provider concerns and issues, as well as other oversight the State deems appropriate.
