Pharmacy Lock-In Program. The Contractor shall submit a monthly report, as defined by the Division, providing information on the Pharmacy Lock-In program in order to monitor services received and reduce unnecessary or inappropriate utilization, as defined by the Division. The Contractor shall submit their policy and criteria for a Member to be locked in. The Contractor must have a drug utilization review program (DUR) to conduct prospective and retrospective utilization review of prescriptions. The DUR program must comply with 42 C.F.R. §438. The Contractor must submit an annual report to the Division that provides a detailed description of its DUR program activities both prospective and retrospective reviews.
Appears in 3 contracts
Samples: Contract for Administration of the Children’s Health Insurance Program, Contract for Administration of the Children’s Health Insurance Program, Contract for Administration of the Children’s Health Insurance Program
Pharmacy Lock-In Program. The Contractor shall submit a monthly report, as defined by the Division, providing information on the Pharmacy Lock-In program in order to monitor services received and reduce unnecessary or inappropriate utilization, as defined by the Division. The Contractor shall submit their policy and criteria for a Member to be locked in. The Contractor must have a drug utilization review program (DUR) to conduct prospective and retrospective utilization review of prescriptions. The DUR program must comply with 42 C.F.R. §438. The Contractor must submit an annual report to the Division that provides a detailed description of its DUR program activities both prospective and retrospective reviews.reviews.
Appears in 1 contract
Samples: Contract for Administration of the Children’s Health Insurance Program
