Preferred Drug List. The Department shall place Covered Products in an advantaged position relative to non-preferred products regarding Preferred Drug List status, and depending on the designated preferred tier, the Department may place Covered Products in an advantaged position relative to other preferred products, “Step Care.” Certain preferred drugs, including Step Care drugs, may be subject to prior authorization, i.e., preferred but with prior authorization. The Department will comply with all provisions of 42 U.S.C. § 1396r-8(d). Drugs of manufacturers who do not participate in the supplemental rebate program will be made available to Medicaid beneficiaries but may be subject to prior authorization.
Preferred Drug List. (A) The Contractor shall develop policies and procedures to govern prescription drug Service Authorization Requests , the policies and procedures shall follow those same Service Authorization Requests policies found in Article 7 and shall be in accordance with 42 CFR 438.210.
(B) The Contractor may use the Department’s Preferred Drug List or may create its own Preferred Drug List.
(C) If the Contractor decides to create its own Preferred Drug List, the Contractor’s Preferred Drug List shall adhere to the following requirements:
(1) On a yearly basis, the Contractor’s Preferred Drug list and the methodology used by the Contractor to set is Preferred Drug List shall be subject to review by the Department’s P&T Committee. Additionally, the P&T Committee at its discretion, may request and review Contractor’s Preferred Drug List and require the Contractor to provide an explanation of the methodology used by the Contractor in making its Preferred Drug List.
(i) The Contractor shall provide any documents requested by the P&T Committee within 15 days of the request.
(ii) The Department’s P&T Committee may require the Contractor to amend its Preferred Drug List if the Board determines that the Contractor’s Preferred Drug List violates this Contract, violates applicable State and Federal Laws, or appears to create an adverse selection process.
(2) The Contractor shall make its Preferred Drug List, and the criteria used to create the Preferred Drug List available to the Department and to Contractor’s Enrollees, upon request.
(3) If the Contractor fails to respond to P&T Committee request for information in a timely manner, the Department may impose sanctions as described in Article 14 of this Contract.
(4) The Contractor may file a request for an administrative hearing if it disagrees with the decision made by the Department’s P&T Committee. The Contractor shall file its request for a State Fair hearing within 30 days of the P&T Committee’s decision.
Preferred Drug List. The Department will place Covered Products in an advantaged position relative to non-preferred products regarding the Preferred Drug List status, and depending on the designated preferred tier, the Department may place Covered Products in an advantaged position relative to other preferred products (Step Therapy). Certain Preferred Drugs, including Step Therapy drugs, may be subject to prior authorization. The Department will comply with all provisions of Section 1927 (d) (42 USC 1396r 8(d))
Preferred Drug List. To be eligible for the Supplemental Rebates specified in Attachment B:
a) State shall place and maintain Covered Product(s) on the Preferred Drug List, it being agreed that utilization shall be eligible for the State Supplemental Rebate only in quarters in which Covered Product(s) is listed on the Preferred Drug List; and
b) State shall place Covered Product(s) in an advantaged position relative to non-preferred Competitive Product(s) regarding Preferred Drug List status, and
c) Depending on the designated preferred tier, the State shall place Covered product(s) in an advantaged position relative to other preferred products (Step Care). Non-Preferred and Step Care drugs may be subject to prior authorization. Criteria for approving prior authorization will be the responsibility of the DUR Committee. These criteria will meet generally accepted clinical standards of practice for the proper use of drugs, and
d) State shall have on file the fully executed CMS Exemption Letter, attached hereto as Exhibit C and incorporated by reference.
Preferred Drug List. This is a listing of prescription drugs established by Aetna or an affiliate. This list is subject to periodic review and modification by Aetna. A copy of the preferred drug list will be available upon the covered person’s request or may be accessed on the Aetna website at xxx.xxxxx.xxx/xxxxxxxxx. This is a group of medications determined by Aetna that may be available at a reduced copayment/coinsurance and are noted on the preferred drug list.
Preferred Drug List. Is a list of preferred medications that requires a patient to try the preferred medication before using a non-preferred medication. • Prospective Drug Utilization Review (ProDUR) Activities – ProDUR activities are automated, structured, ongoing review of prescribing, dispensing and use of medications. Table 5 Measures to Control Costs during CY 2021 Utilization Management Prior Authorization Yes Step Therapy Yes Quantity Limits Yes Pharmacy Networks Yes Preferred Drug List Yes ProDUR Activities Yes The overall drug rebate process follows the Omnibus Budget Reconciliation Act of 1990 (OBRA ’90) as codified in Section 1927 of the Social Security Act (42 U.S.C. 1396r-8) and regulations promulgated by the Centers for Medicare & Medicaid Services (CMS). Under the Medicaid Drug Rebate Program (MDRP), drug manufacturers must provide rebates to the federal government and states as a condition of having their drugs covered by Medicaid. The MDRP helps lower Medicaid prescription drug spending by ensuring that state Medicaid agencies receive discounts in the form of rebates on covered outpatient drugs. In order for their covered outpatient drugs to be covered and reimbursed by state Medicaid agencies, pharmaceutical manufacturers enter into and have in effect the National Drug Rebate Agreement (NDRA) with the Secretary of the United States Department of Health and Human Services (HHS). The NDRA provides for the payment of Federal rebates by pharmaceutical manufacturers. Nevada Medicaid and the other state Medicaid Programs are third party beneficiaries of the NDRAs. The formulas for calculating the Federal Unit Rebate amount (URA) are set out by Federal statute. States may also directly negotiate with manufacturers for voluntary supplemental rebates on top of federally required rebates. States may enter into separate or supplemental drug rebate agreements as long as such agreements achieve drug rebates equal to or greater than the drug rebates set forth in the Secretary’s national rebate agreement with drug manufacturers, which is published at 56 F.R. 7049 (1991). The supplemental rebate does not reduce what is being paid under the NDRA but instead, provides an additional tool for states to help manage prescription drug spend. Pharmaceutical manufacturers enter into supplemental rebate agreements (SRA) with state Medicaid agencies to ensure preferred status on the states’ Preferred Drug Lists (PDL). The SRAs are between the manufacturers and the Pharmacy Benefit Mana...
Preferred Drug List. As a part of its process of drug prior authorization, DMMA shall adopt and maintain a Preferred Drug List. No Contracted Product on the Preferred Drug List shall be discouraged or disadvantaged in any way relative to any other single source brand name prescription drug in its therapeutic class unless specifically stated otherwise on the Contracted Products Attachment. Notwithstanding the forgoing, DMMA may apply prior authorization, step therapy or similar controls to all products in a particular therapeutic class, or where the Manufacturer has explicitly agreed to the terms of such controls in writing as part of its State Supplemental Rebate terms, without violation of this Section 6.2.
Preferred Drug List. The Department shall maintain and publish a Preferred Drug List that will be applicable to fee-for-service program and Medicaid Managed Care Plans providing a pharmacy benefit to Medicaid beneficiaries. Preferred Products shall not be discouraged or disadvantaged in any way relative to any other drug product in its therapeutic class unless specifically stated otherwise in the Contracted Products Attachment of this Agreement. The Department may apply clinical edits, prior authorization, step therapy or similar utilization management controls to a Preferred Product. The Department may also apply other clinical edits, prior authorization, step therapy or similar utilization management controls equally to all products in a therapeutic class.
Preferred Drug List. A Preferred Brand Name Drug is subject to the Preferred Brand Name Drug Copayment plus any applicable pricing differences. These drugs are identified on the preferred drug list. HMO will periodically review the preferred drug list and adjust it to modify the preferred/non- preferred Brand Name Drug status of new and existing drugs. Changes to the preferred drug list will be implemented on the next renewal date of the Group Agreement and are subject to the requirements of Texas Insurance Code, 1369.0541. The applicable preferred drug list is indicated in the SCHEDULE OF COPAYMENTS AND BENEFIT LIMITS. The preferred drug list and any modifications thereto will be made available to Members. The preferred drug list is available by accessing the website at xxx.xxxxxx.xxx/xxxxxxxx or by contacting customer service at the toll- free number on Your identification card. Drugs that do not appear on preferred drug list are subject to the Non- Preferred Drug Copayment and any applicable pricing differences.
Preferred Drug List. As a part of its process of drug prior authorization, the Department shall adopt and maintain a Preferred Drug List. No Product on the Preferred Drug List shall be discouraged or disadvantaged in any way relative to any other brand name product in its therapeutic class on or off the Preferred Drug List unless otherwise agreed to by both parties and as indicated in Attachment A.
