Specialty Pharmacy Clause Samples

Specialty Pharmacy. A pharmacy which dispenses biotech drugs for rare and chronic diseases via scheduled drug delivery either to the Member’s home or to a Physician’s office. These pharmacies also provide telephonic therapy management to ensure safety and compliance. Correction of subluxations in the body to remove nerve interference or its effects. Interference must be the result of or related to distortion, misalignment or subluxation of or in the vertebral column.

Specialty Pharmacy. Claim Administrator and Prime have contracted with Specialty Pharmacies and/or vendors to provide Members with access to in-network benefits for covered Specialty Drugs.

Specialty Pharmacy. Notwithstanding the foregoing, the clinical programs described herein shall not impair a member’s right to appeal any adverse decision in accordance with the appeals rights described in the SPD. Further, a member or the member’s physician may seek an exception to one or more otherwise applicable clinical programs listed above.

Specialty Pharmacy. PBM shall provide the following services from its specialty pharmacy: (i) receive prescriptions for Specialty Drugs, as identified in the Specialty Drug List (which is a fixed list amended from time to time under rules described in Exhibit C), subject to and in accordance with the Plan Design Document. (ii) fill prescriptions, subject to the professional judgment of the dispensing pharmacist via U.S. mail or commercial carrier or facsimile machine at an address or telephone number specified by PBM from time to time; (iii) provide Members dedicated toll-free telephone access to a pharmacist and customer service representatives; (iv) provide to Participating Group promotional materials that explain to Members how to use the specialty service program, as well as any other materials Members may require to begin using the specialty program and Participating Group shall distribute such information to Members; (v) provide computerized drug interaction monitoring of Members based upon the Member profile, programs for generic substitution and therapeutic intervention, pharmaceutical cost containment services and safety edits, and subject to prescriber approval, clinical appropriateness, the terms of the Participating Group Plan and applicable law; (vi) ship all prescription orders to Members via U.S. Postal Service or other appropriate carrier to the address provided by Participating Group and/or the Member, as long as such addresses are located in the United States or location that permits delivery of prescriptions through such means; and (vii) not dispense drugs if the prescription is not accompanied by the Cost Sharing as applicable. (viii) New Specialty Drugs that fall into an existing therapeutic class will be priced at that therapeutic class rate as set forth under Exhibit C. This provision shall include any drugs that PBM deems to be a bio- similar product. (ix) A Participating Group without incurring an increase in specialty drug discount costs from PBM. Neither Client nor CCOG may contract with an additional Specialty Vendor on behalf of Participating Groups. (x) ii) Specialty Pharmacy contracted rate plus zero charge for the product or (iv) Ingredient Cost Submitted.

Specialty Pharmacy. AdvancePCS’ specialty pharmacy service will be provided by an AdvancePCS specialty pharmacy entity or its affiliate (“AdvancePCS SpecialtyRx”), and offers a distribution channel for certain pharmaceutical products that are generally biotechnological in nature, are given by injection, or otherwise require special handling (“Specialty Medications”). AdvancePCS SpecialtyRx shall provide prescription fulfillment and distribution of Specialty Medications and supplies, pharmaceutical care management services, as well as the types of Service that Member County receives under this Agreement, including but not limited to customer services, utilization and clinical management, integrated reporting and Claims processing (“SpecialtyRx Services”). AdvancePCS SpecialtyRx may receive prescriptions from Participants through an affiliated AdvancePCS mail facility or directly via the U.S. Mail or commercial carrier at the address specified by AdvancePCS from time to time and may also receive prescriptions from physicians by fax or by U.S. Mail/commercial NAOC_k2_v2.doc (07/06/2005) [RxClaim] Page 3 of 16 carrier. In accordance with the Consumer Card Program, AdvancePCS SpecialtyRx shall dispense Covered Items in accordance with those prescriptions and mail the Covered Items to Participants at the designated address, so long as such address is located within the United States. AdvancePCS SpecialtyRx may not dispense drugs to Participants who fail to submit the correct payment with their prescription. AdvancePCS SpecialtyRx pharmaceutical care management services include but may not be limited to: (1) patient profiling focusing on the appropriateness of Specialty Medication therapy and care and the prevention of drug-drug interactions; (2) patient education materials; and (3) disease management and compliance programs with respect to Specialty Medications. As part of these services, Participants will be asked to participate in various surveys. AdvancePCS will provide Member County and Customer with a list of the Specialty Medications and their corresponding rates (which may vary from Network Rates) upon request. Routine supplies (needles, syringes, alcohol swabs) in a sufficient quantity will be included at no additional expense.

Specialty Pharmacy. A pharmacy that has a contract with Us and is designated by Us as a Specialty Pharmacy who provides certain Covered Drugs, including, but not limited to, Prescription Drugs and Self- Administered Injectable and Specialty Drugs Orders or Refills.

Specialty Pharmacy. Pricing proposal assumes an exclusive specialty arrangement with If a Participating Group requires other specialty pharmacy arrangements, the parties will discuss separate contractual terms and conditions on a case-by-case basis. Under an exclusive arrangement, grace fills at retail will not be allowed. New drugs are added as soon as they hit Medi-Span which is usually on the day or within a few days of product launch. Pricing is available around the same timeline. Newly FDA- approved products will be billed and reimbursed at the Default Rate of AWP 14%.

Specialty Pharmacy. Subject to Section 6.5 of this Agreement, Caremark shall be the exclusive provider of Specialty Drugs to Plan Participants and shall provide the products and services, listed in Exhibit C of the Pricing Agreement (the “Specialty Drug Exhibit”), as follows: (a) Dispense new or refill prescription orders for Specialty Drugs upon receipt from a Plan Participant of (i) a prescription and a completed order or refill order form, and (ii) the applicable Cost Share; (b) Fill prescriptions for Specialty Drugs subject to the professional judgment of the dispensing pharmacist, good pharmacy practices in accordance with local community standards, and product labeling and guidelines; (c) Ship Specialty Drugs to Plan Participants via U. S. Postal Service or other appropriate carriers to the address provided by Participating Group and/or the Plan Participant; (d) Bill major medical benefits through the use of a CMS 1500 form when required subject to pricing terms as outlined in the Pricing Agreement incorporated herein; (e) Provide routine supplies required for the administration of the Specialty Drug (such as needles, syringes, alcohol swabs, etc.) to the extent deemed appropriate by Caremark.

Specialty Pharmacy. Upon Client’s request, Navitus will provide Client a Specialty Pharmaceutical program which provides a distribution channel for certain Covered Products that are generally biotechnological in nature, are given by injection, or otherwise require special handling. The Specialty Pharmacy will dispense Specialty Pharmaceuticals to Eligible Persons subject to the terms set forth in Exhibit 2.