Pharmacy Benefits. The Summary of Pharmacy Benefits only applies to prescription drugs purchased at a retail, mail order, or specialty, pharmacy.
Pharmacy Benefits a. Pharmacy benefits are available to all State of Ohio employees and their dependents enrolled in a health plan.
b. The JHCC will review the procedure for obtaining biotech drugs and upon recommendation of the JHCC, the Director of DAS may require that such biotech drugs be obtained from specialty pharmacies. Furthermore, upon recommendation from the JHCC, the Director of DAS may establish a separate cost-sharing structure for biotech or lifestyle drugs.
c. After consultation with the JHCC, the Director of DAS may review the following:
(1) Alternative pharmacy cost-sharing plan options such as co- insurance.
(2) Coverage of certain Over-the-Counter (OTC) drugs.
(3) Alternative pharmacy procurement and distribution channels.
(4) A special retail generic program.
(5) A retail 90 day maintenance drug program.
d. The pharmacy benefit manager may not remove from its formulary or require preauthorization for any prescription drug that is among its ten (10) most frequently prescribed drugs unless the pharmacy vendor has notified the Employer and consulted with the JHCC, including in that consultation a review of the health plan research recommending that the drug be excluded or put on preauthorization status.
Pharmacy Benefits. Prescription drugs are a benefit under the HIP program to be covered by the Contractor. The Contractor shall support FSSA in promptly responding to public and legislative inquiries involving the design and management of the Contractor’s pharmacy benefit. If the Contractor elects to subcontract with a PBM, the Contractor shall ensure compliance with all subcontracting requirements outlined in Section 2.7, including but not limited to conducting regular audits and monitoring of the subcontractor’s data and performance, as well as requiring their PBM to conduct regular audits of their pharmacy provider networks. The Contractor shall not be responsible for member pharmacy claims incurred prior to the effective date of this contract. The Contractor shall, at the direction of the Secretary, implement specified fee-for- service PDL and/or prior authorization, if unified PDL is not implemented. The Contractor shall develop an escalation process for specified unique review processes and requests submitted by state or federal legislators, the Governor, the Secretary, news media and/or of a controversial nature. The Contractor shall assure that all claims (including emergency claims) from a non-IHCP pharmacy will reject. In addition, all claims (except emergency claims) from a non-IHCP prescribing provider will reject. The Contractor shall provide for ninety (90) days of continuity of care for all pre- existing drug regimens for all new members. This will allow time for the PBM to work with the prescribing provider to negotiate future drug regimens. The Contractor shall assure proper and complete PBM agent training. The Contractor shall ensure that at all times during the term of this contract its pharmacy benefit fully complies with applicable provisions of IC 12-15-35 and IC 12-15-35.5.
Pharmacy Benefits. $2,500 per Calendar Day per occurrence
Pharmacy Benefits. USNH shall provide Bargaining Unit Members and their dependents Pharmacy Benefits consistent with the benefits approved and outlined in USNH Benefit offerings.
Pharmacy Benefits. This section describes coverage for prescription drugs and diabetic equipment/supplies purchased at a retail, specialty, or mail order pharmacy. This section is a part of the Subscriber Agreement and not separate from it. Coverage is provided per the terms, conditions, exclusions, and limitations of this Subscriber Agreement.
Pharmacy Benefits. $5,000 per standard authorization request $7,500 per expedited authorization request
15. Failure to allow a Member to obtain a second medical opinion at no expense and regardless of whether the provider is a network provider as specified Section V.D.1. Provider Network. $1,000 per occurrence
16. Failure to follow Department required Clinical Coverage Policies as specified Section V.C.1.
Pharmacy Benefits a. Pharmacy benefits are available to all State of Ohio employees and their dependents enrolled in a health plan. Pharmacy benefits may be provided by the individual health plan or upon the recommendation of the JHCC, the Director of DAS may carve-out pharmacy benefits from the health plans.
b. The JHCC will review the procedure for obtaining biotech drugs and upon recommendation of the JHCC, the Director of DAS may require that such biotech drugs be obtained from specialty pharmacies. Furthermore, upon recommendation from the JHCC, the Director of DAS may establish a separate cost-sharing structure for biotech or lifestyle drugs.
c. After consultation with the JHCC the Director of DAS may implement the following:
(1) Alternative pharmacy cost-sharing plan options such as co-insurance.
(2) Coverage of certain Over-the-Counter (OTC) drugs.
(3) Alternative pharmacy procurement and distribution channels.
d. No health plan may remove from its formulary or require preauthorization for any prescription drug that is among its ten most frequently prescribed drugs unless the health plan has notified the Employer and consulted with the JHCC, including in that consultation a review of the health plan research recommending that the drug be excluded or put on preauthorization status.
e. Retail pharmacy program. There will be a program for short- term (up to thirty (30) days) prescriptions, with easy access to pharmacies throughout the state. Commencing July 1, 2006, co-pays for a thirty (30) day supply of prescription drugs including coverage of prescriptions from a licensed dentist are: $10 co-payment for generic, twenty dollar ($20) co-pay for a formulary brand name drug, and a forty dollar ($40) co- pay for a non-formulary brand name drug. Where a generic equivalent is available, the co-pay for a non-formulary brand name drug shall be forty dollar ($40) and the difference in cost between the generic equivalent and the non-formulary brand name drug. Commencing July 1, 2007 the following drug co- pays shall apply. Co-pays for a thirty (30) day supply of prescription drugs including coverage of prescriptions from a licensed dentist are: ten dollar ($10) co-payment for generic, twenty-two dollar ($22) co-pay for a formulary brand name drug, and a forty-four dollar ($44) co-pay for a non-formulary brand name drug. Where a generic equivalent is available, the co-pay for a non-formulary brand name drug shall be forty- four dollar ($44) and the difference in cost between th...
Pharmacy Benefits. C. Table 5: Medicaid Managed Care Cost Sharing is revised and restated as follows: INCOME LEVEL ANNUAL ENROLLMENT FEE SERVICE COPAY Medicaid North Carolina Health Choice (NCHC) INCOME LEVEL ANNUAL ENROLLMENT FEE SERVICE COPAY
Pharmacy Benefits. Contractor will provide prescription drug coverage through ___________________. Online services are available through ___________ at www.______________.com. .
