Common use of Pharmacy General Requirements Clause in Contracts

Pharmacy General Requirements. The Contractor shall administer pharmacy benefits in accordance with this section, other requirements specified in this Contract, and in accordance with all applicable State and Federal laws and regulations. In accordance with the Contractor’s Formulary and/or Preferred Drug List, the Contractor shall provide coverage for all medically necessary legend and non-legend drugs once a drug becomes FDA approved and eligible for manufacturer federal rebates in accordance with Section 1927 of the Social Security Act, and ensure the availability of quality pharmacy services for all enrollees. Pharmacy benefit requirements shall include, but not be limited to: A. State-of-the-art, online and real-time rules-based point-of-sale (POS) claims processing services with prospective drug utilization review (ProDUR) and edits; B. An accounts receivable (A/R) process that includes records for the Department to systematically track adjustments, recoupments, manual payments, and other required identifying A/R and claim information; C. Retrospective drug utilization review (RetroDUR) services; D. Formulary and non-formulary services, including but not limited to, prior authorization (PA) services, a PA escalation process and procedure, an appeals process, and a Pharmacy and Therapeutics Committee; E. Pharmacy Provider relations and education, and call center services (member and provider), in addition to provider services specified elsewhere; F. Seamless interfaces with the information systems of the Department and as needed, any related vendors;