Pharmacy Benefit Services Sample Clauses

Pharmacy Benefit Services. United or its affiliate will provide the Pharmacy Benefit Services described in this Section 4.6. United will make Network Pharmacies available to Customer Participants, through United’s affiliate. United will determine which pharmacies are Network Pharmacies. Network Pharmacies can change at any time. United will make a reasonable effort to provide Customer with advance notice if any material changes occur to the network. Upon request, United will provide Customer information on the reimbursement rate to United’s affiliated Network Pharmacies. Mail Order Pharmacy Services. United will provide, through United’s affiliate, mail order pharmacy services for Customer’s Participants. Customer’s pricing terms for mail order pharmacy services are based on package sizes of 100 units, 16 ounce quantities or the next closest quantity available and at least a 46 day supply. Prescriptions filled through the mail order pharmacy that are less than a 46 day supply will be processed at retail pricing and will be counted with retail utilization. United will retain the difference between the package size of 100 units or 16 ounces and the actual manufacturer’s package size which the mail order pharmacy’s price is based on. Prescription Drug List (PDL) Customer has adopted one or more of United’s PDLs for use with Customer’s benefit plans. Customer agrees not to copy, distribute, sell, or otherwise provide the PDL to another party without United’s prior written approval, except to Participants as described below. On termination of this Agreement or if Customer terminates the Pharmacy Benefit Services portion of this Agreement, Customer will stop all use of the PDL. While Customer is the ultimate decision-maker on selecting the design of Customer’s PDL(s), Customer has requested that United supply and assist Customer with, certain PDL development and management functions including but not limited to drug tiering decisions. United’s intent is to provide Customer with the same PDL and management strategies that United develops and employs in the management of United’s fully insured business. United makes the final classification of an FDA-approved prescription drug product to a certain tier of the PDL by considering a number of factors including, but not limited to, clinical and economic factors. Clinical factors may include, but are not limited to, evaluations of the place in therapy, relative safety or relative efficacy of the prescription drug product, as well as whether supp...
Sample 1
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Pharmacy Benefit Services. We will make Network Pharmacies available to Your Participants. We will determine which pharmacies are Network Pharmacies. Network Pharmacies can change at any time. We will make a reasonable effort to provide You with advance notice if any material changes occur to the Network Pharmacy. We will provide You information on the reimbursement rate to Our affiliate Network Pharmacy for specialty pharmacy. Home Delivery Pharmacy Services. We will provide home delivery pharmacy services for Your Participants. Your pricing terms for home delivery pharmacy services are based on package sizes of 100 units, 16 ounce quantities or the next closest quantity available and at least a 46 day supply. Prescriptions filled through the home delivery pharmacy that are less than a 46 day supply will be processed at retail pricing and will be counted with retail utilization. We will retain the difference between the package size of 100 units or 16 ounces and the actual manufacturer’s package size which the home delivery pharmacy’s price is based on. Prescription Drug List (PDL) You have adopted one or more of Our PDLs for use with Your benefit plans. You agree not to copy, distribute, sell, or otherwise provide the PDL to another party without Our prior written approval, except to Participants as described below. On termination of this Agreement or if You terminate the Pharmacy Benefit Services portion of this Agreement,, You will stop all use of the PDL. While You are the ultimate decision-maker on selecting the design of your PDL(s), You have requested that We supply, and We have assisted You with, certain PDL development and management functions including but not limited to drug tiering decisions. Our intent is to provide You with the same PDL and management strategies that We develop and employ in the management of our fully insured business. We make the final classification of an FDA-approved prescription drug product to a certain tier of the PDL by considering a number of factors including, but not limited to, clinical and economic factors. Clinical factors may include, but are not limited to, evaluations of the place in therapy, relative safety or relative efficacy of the prescription drug product, as well as whether supply limits or notification requirements should apply. Economic factors may include, but are not limited to, the prescription drug product's acquisition cost including, but not limited to, available Rebates, and assessments on the cost effectiveness of the...
Sample 1

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