Prescription Drug Services. The Contractor shall provide pharmacy services to Members enrolled in the MississippiCAN Program. The Contractor shall comply with the Mississippi Pharmacy Practice Act and the Mississippi Board of Pharmacy rules and regulations. The Contractor is restricted from requiring Members to utilize a pharmacy that ships, mails, or delivers prescription drugs or devices. However, the Contractor may implement a mail-order pharmacy program in accordance with State and Federal law. The Contractor must use the most current version of the Medicaid Program Preferred Drug List (PDL), which is subject to periodic changes. The Contractor must use the Medicaid PDL developed by the Division or its Agent and may not develop and use its own PDL. The Contractor will be provided opportunities to offer feedback on the PDL to the Pharmacy and Therapeutics Committee, which is an advisory panel that conducts in-depth clinical evaluations and recommends appropriate drugs for preferred status on the PDL and/or drugs for Prior Authorization. The Executive Director of the Division has final authority on drugs with preferred status on the PDL and/or drugs for Prior Authorization. Refer to the Pharmacy Services page on the Division’s website for a current listing of prescription drugs on the PDL to ensure continuity of care for Members. The Contractor may approve drugs outside the PDL in accordance with Section 5.J, Prior Authorizations, of this Contract. The Contractor must cover and pay for a minimum of a three (3)-day emergency supply of prior authorized drugs until authorization is completed. The Contractor shall ensure that prescription drugs are prescribed and dispensed in accordance with medically accepted indications for uses and dosages. No payment may be made for services, procedures, supplies or drugs which are still in clinical trials and/or investigative or experimental in nature. The Contractor may consider exceptions to the criteria if there is sufficient documentation of stable therapy as reflected in ninety (90) calendar days of paid Medicaid claims. The Contractor is not authorized to negotiate rebates with drug companies for preferred pharmaceutical products. The Division or its Agent will negotiate rebate agreements. If the Contractor or its Subcontractor has an existing rebate agreement with a manufacturer, all Medicaid outpatient drug claims, including Provider-administered drugs, must be exempt from such rebate agreements. Please refer to Mississippi Administrativ...
Prescription Drug Services. 12.7(a) The Prescription Drug Program will cover medically necessary drugs requiring a physician's prescription and dispensed by a licensed pharmacist. Coverage will be provided under the Empire Plan Prescription Drug Program for prescription vitamins and contraceptives.
Prescription Drug Services. The term “
Prescription Drug Services. The Contract must provide Pharmacy Benefit Management (PBM) services as necessary to meet the requirements of the HRPP. These services include, but are not limited to: Provide retail, Mail Order Services, and Specialty Drug benefit programs and a pharmacy network with convenient access for Members. Provide claim services, claim eligibility verification, claim payment or denial, claims tracking and review of claim appeals. Manage the provider network, which is expected to provide one or more participating pharmacies located within a convenient distance of enrollee residences, provided there is a pharmacy available. Provide utilization management programs, such as Prior Authorization, Clinical Authorization, Step Therapy, and Drug Quantity Management programs. Provide and manage a prescription drug formulary that ensures quality and maximizes savings through formulary management. Reduce and control the cost of prescription drugs. The Contractor must ensure and report that the following standards are included in new, renewing or amended contracts with vendors (Subcontractors) providing a retail pharmacy network and/or a mail order pharmacy to enrollees (hereafter “PBM”) effective on or after the effective date of the Contract.
Prescription Drug Services. The Contractor shall provide pharmacy services either directly or through a subcontractor. -------------------------------------------------------------------------------- CONTRACT NO.: P0HC-2002-D-0003 62 -------------------------------------------------------------------------------- --------------------------------------------------------------------------------
Prescription Drug Services. CITY desires to participate in BRMS’s arrangement with the Pharmacy Benefit Management Services (PBM) for the provision of prescription drug and drug utilization review services and mail order pharmacy program through the PBM pharmacy network, therefore, the parties agree that PBM shall provide the following services:
