Prescribed Drug Services Sample Clauses

Prescribed Drug Services a. The Health Plan shall provide those products and services associated with the dispensing of medicinal drugs pursuant to a valid prescription, as defined in Chapter 465, F.S. Prescribed Drug Services generally include all prescription drugs listed in the Agency’s Prescribed Drug List (“PDL”). See Section 409.91195, F.S. The PDL shall include at least two (2) products, when available, in each therapeutic class. Antiretroviral agents are not subject to the PDL. Pursuant to Section 409.912(39), F.S., policy requirements include, but are not limited to, the following: (1) The Health Plan shall make available those drugs and dosage forms listed in the PDL. (2) The Health Plan shall not arbitrarily deny or reduce the amount, duration or scope of prescriptions solely based on the Enrollee’s diagnosis, type of illness or condition. The Health Plan may place appropriate limits on prescriptions based on criteria such as Medical Necessity, or for the purpose of utilization control, provided the Health Plan reasonably expects said limits to achieve the purpose of the Prescribed Drug Services set forth in the Medicaid State Plan. (3) The Health Plan shall make available those drugs not on the PDL, when requested and approved, if the drugs on the PDL have been used in a step therapy sequence or when other documentation is provided. (4) The Health Plan shall submit an updated PDL to the Agency annually, by October 1 of each Contract Year, and provide thirty (30) days written notice of any changes to the Bureau of Managed Health Care and Pharmacy Services. b. The Health Plan shall provide to Enrollees, who desire to quit smoking, one (1) course of nicotine replacement therapy, of twelve (12) weeks duration, or the manufacturer’s recommended duration, per year. The Health Plan may use either nicotine transdermal patches or nicotine gum. c. If the Health Plan has authorization requirements for prescribed drug services, the Health Plan shall comply with all aspects of the Settlement Agreement to Xxxxxxxxx, et. al.
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Prescribed Drug Services a. The Health Plan shall provide those products and services associated with the dispensing of medicinal drugs pursuant to a valid prescription, as defined in Chapter 465, F.S. Prescribed drug services generally include all prescription drugs listed in the Agency’s Preferred Drug List (PDL). See s. 409.91195, F.S. The Health Plan’s PDL shall include at least two (2) products, when available, in each therapeutic class. Pursuant to s. 409.912(39), F.S., policy requirements include, but are not limited to, the following: (1) The Health Plan shall make available those drugs and dosage forms listed in its PDL. (2) The Health Plan shall not arbitrarily deny or reduce the amount, duration or scope of prescriptions solely based on the enrollee’s diagnosis, type of illness or condition. The Health Plan may place appropriate limits on prescriptions based on criteria such as medical necessity, or for the purpose of utilization control, provided the Health Plan reasonably expects said limits to achieve the purpose of the prescribed drug services set forth in the Medicaid State Plan. HealthEase of Florida, Inc. Medicaid HMO Non-Reform Contract (3) The Health Plan shall make available those drugs not on its PDL, when requested and approved, if the drugs on the PDL have been used in a step therapy sequence or when other medical documentation is provided. (4) The Health Plan shall submit an updated PDL to BMHC and the Bureau of Pharmacy Services by October 1 of each Contract year, and provide thirty (30) days’ written notice of any changes. If the Health Plan adopts the Medicaid PDL, the Health Plan shall be exempt from such reporting. Information on the Health Plan’s use of the PDL is in Attachment I and Attachment II, Exhibit 5. (5) Antiretroviral agents are not subject to the PDL.
Sample 1
Prescribed Drug Services. Prescribed drug services for dual eligible Medicaid beneficiaries are covered as per the Medicare Modernization Act (MMA). However, section 103(c) of the MMA added s. 1935(d)(2) to the Social Security Act to allow State Medicaid programs to continue to provide and receive Federal Financial Participation (FFP) for certain drugs not included in the Medicare Prescription Drug benefit (Part D). Drugs excluded from Part D coverage are listed in s. 1927(d)(2) of the Act. Contractors shall provide certain drugs not included in Part D as described in the Medicaid Prescribed Drugs Services and Limitations Handbook. The Contractor’s pharmacy benefits management program must comply with all applicable federal and state laws.
Sample 1
Prescribed Drug Services. Products and services associated with dispensing medicinal drugs pursuant to a valid prescription as defined in Chapter 465, Florida Statutes (the "Florida Pharmacy Act"). This benefit generally includes all legend drugs dispensed to enrollees in outpatient settings and includes patent or proprietary preparations. Covered drugs, injectables and other prescribed drug services are described in the Prescribed Drugs Services and Limitations Handbook. These services also include payment for Medicaid reimbursable psychotropic drugs. The contractor must furnish those drugs in dosage forms currently covered by the Medicaid Program and must not place a dollar limit on this service. The contractor must not have a pharmacy benefits management program that is more restrictive than Medicaid fee-for-service. The contractor's pharmacy benefits management program must comply with all applicable federal and state laws.
Sample 1
Prescribed Drug Services. Prescribed drug services for dual eligible Medicaid beneficiaries are covered as per the Medicare Modernization Act (MMA). However, section 103(c) of the MMA added s.1935(d)(2) to the Social Security Act to allow State Medicaid programs to continue to provide and receive Federal Financial Participation (FFP) for certain drugs not included in the Medicare Prescription Drug benefit (Part D). Drugs excluded from Part D coverage are listed in s.1927(d)(2) of the Act. Contractors shall provide certain drugs not included in Part D as described in the Medicaid Prescribed Drugs Services and Limitations Handbook. The contractor’s pharmacy benefits management program must comply with all applicable federal and state laws. Vision Services: Medically necessary eye examinations. Eyeglass repairs and adjustments. Eyeglass frames are limited to one pair every two years. Prior authorization is required for a second pair every two years, and eyeglass frames within the two-year period and also for a second pair of lenses within a 365day period. Such services must be provided in accordance with the policy and service provisions specified in the Medicaid Vision Services Coverage and Limitations Handbook, and must be provided by providers licensed under Chapter 484, Part I, or 463, F.S. Hospice Services: End of life services provided to enrollees electing hospice services. Services will be provided in accordance with the policy and services provisions specified in the Hospice Services Coverage and Limitations Handbook.
Sample 1
Prescribed Drug Services. Prescribed drug services for dual eligible Medicaid beneficiaries are covered as per the Medicare Modernization Act (MMA). However, section 103(c) of the MMA added s.1935(d)(2) to the Social Security Act to allow State Medicaid programs to continue to provide and receive Federal Financial Participation (FFP) for certain drugs not included in the Medicare Prescription Drug benefit (Part D). Drugs excluded from Part D coverage are listed in s.1927(d)(2) of the Act. Contractors shall provide certain drugs not included in Part D as described in the Medicaid Prescribed Drugs Services and
Sample 1

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