Pharmacy. Prescription drugs are a benefit under the Hoosier Healthwise 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 provide a proposal which considers a common or “unified” preferred drug list (PDL) for the pharmacy benefit. Unification of the PDL would include prior authorization (PA), step edit, and utilization edit criteria. 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. 2 For CHIP, coverage of treatment services is limited to the Package C benefit package coverage limitations.
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Samples: Contract, Contract Amendment, Contract
