Covered Prescription Services definition

Covered Prescription Services means the services usually and customarily rendered by a pharmacy in the normal course of business, including but not limited to dispensing, counseling, pharmaceutical care, product consultation, and pharmacy services as otherwise defined by the state in which the pharmacy is licensed.

Covered Prescription Services means those Prescription Drugs and other pharmaceutical products, services and supplies dispensed by Administrator to a Member for which coverage is provided pursuant to the terms and conditions of the Benefit Plan. Covered Prescription Services shall not include any Drug Product that satisfies the definition of a Specialty Drug.

Covered Prescription Services means the prescriptions and other products and services that may be dispensed or provided by Pharmacy to which a Member is entitled to receive in accordance with and subject to the terms and conditions of the Plan.

Examples of Covered Prescription Services in a sentence

• Some Covered Prescription Services may have additional requirements or limits that help ensure safe and effective use.

• For claims submitted for Medicare Part B Covered Prescription Services for the respective Benefit Plan Sponsor’s MA or MA-PD Benefit Plans, Network Pharmacy Provider shall refer to the POS System response for the applicable Benefit Plan as payment in full.

• Failure to submit all Part D Covered Prescription Services may impact Part D Sponsor’s STAR ratings as well as individual Medicare Drug Plan Member’s benefit calculations.

• Network Pharmacy Providers shall at all times submit Part D Covered Prescription Services to Medicare Drug Plan Members via the POS System to Claims Processor and furnish Part D Covered Prescription Drugs in a manner that permits the Part D Sponsor to comply with Medicare laws and regulations.

• This section shall be considered a part of the Agreement by and between Administrator and Network Pharmacy Provider (including all amendments, addenda or Compensation Exhibits) to the extent the Network Pharmacy Provider provides Covered Prescription Services to Members in applicable states.

• Certain state or local jurisdictions may impose a tax on Covered Prescription Services.

• PHARMACY shall submit Claims for Covered Prescription Services to Claims Processor, in the manner required hereunder, for adjudication, processing, and payment on behalf of the Plan Sponsors.

• PHARMACY shall ensure that Claims for Covered Prescription Services to Claims Processor are submitted via real time, point-of-sale communication.

• PHARMACY shall adopt operational processes, procedures, and protocols to furnish Covered Prescription Services to Members in an orderly, efficient, professional, and competent manner.

• Such Covered Prescription Services provided by PHARMACY as a result of a positive adjudication shall entitle PHARMACY to reimbursement for those Covered Prescription Services.