Specialty Pharmacy. The City’s PBM will determine which drugs are included in any or all of these clinical programs and the applicable quantity level limits subject to the restrictions noted above.
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. 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. 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. 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. As elected by Sponsor on the Set-Up Forms, Members may have prescriptions filled through ESI Specialty Pharmacy on an exclusive basis (i.e., “ESI Specialty Pharmacy – Exclusive Care”) or at Participating Pharmacies and through ESI Specialty Pharmacy (i.e., “ESI Specialty Pharmacy – Open Care”). Subject to applicable law, ESI and ESI Specialty Pharmacy may communicate with Members and physicians to advise Members filling Specialty Products at Participating Pharmacies of the availability of filling prescriptions through ESI Specialty Pharmacy.
(i) ESI will notify Sponsor and Aon Xxxxxx monthly of any new Specialty Products that are introduced to the market on or after the Effective Date of this Agreement with their applicable reimbursement rates (“Notice”). Only newly FDA-approved and launched Specialty Products may be considered for addition to the Specialty Product List. Notice will be provided in advance of any modification with an explanation of the rationale for such modification. On a quarterly basis on the first business day of the first month of the quarter, ESI shall provide Aon Xxxxxx and Sponsor with a revised and complete Specialty Product List noting the effective date for each modification. The parties agree as follows:
(A) If Sponsor has expressly excluded a specific therapy class or product on a Set-Up Form, Specialty Products in such excluded classes will automatically be deemed excluded from coverage and will reject as “NDC Not Covered” through Participating Pharmacies, Mail Service Pharmacy and ESI Specialty Pharmacy; otherwise, subject to (B) below, all other Specialty Products will be implemented as Covered Drugs at the rate specified in the applicable Specialty Product List or Notice. If Sponsor desires to cover otherwise excluded Specialty Products, Sponsor must notify ESI in writing that it desires to cover the Specialty Product before ESI will adjudicate as a Covered Drug, and if ESI receives such confirmation of coverage from Sponsor such Specialty Product will be loaded thereafter as a Covered Drug at the applicable reimbursement rate set forth in the Notice.
(B) Sponsor must notify ESI in writing if it wants to exclude the Specialty Product from coverage. The exclusion will be implemented within seven (7) business days after the date of ESI’s receipt of such notification. There will not be any retroactive denials for Prescription Drug Claims processed prior to ESI’s receipt of the rejection notice and implementation of the exclusi...
Specialty Pharmacy. A pharmacy that dispenses generally low volume and high cost medications to patients who are undergoing intensive therapies for illnesses that are generally chronic, complex and potentially life threatening. Often these therapies require specialized delivery and administration. Require patient counseling/ support/compliance management.
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.
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. 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.
