Prescription Drug Claim definition

Prescription Drug Claim means a Member Submitted Claim, Subrogation Claim or claim for payment submitted to ESI by a Participating Pharmacy, Mail Service Pharmacy, or ESI Specialty Pharmacy as a result of dispensing Covered Drugs to a Member.
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Prescription Drug Claim means an EGWP Enrollee Submitted Claim or claim for payment of a Covered Drug submitted to MCLIC by a Pharmacy.
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Prescription Drug Claim means a Member Submitted Claim or claim for payment submitted by a Participating Pharmacy as a result of dispensing a Covered Drug to a Member.
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Examples of Prescription Drug Claim in a sentence

  • Check with your pharmacy to be sure they participate, or call us at 1-800-552-2682.If you choose a pharmacy out of the network, you’ll need to pay the total cost of the drug when you pick it up, and then file a Prescription Drug Claim Form to get reimbursed.

  • When Drugs are obtained at a non-Participating Pharmacy for a covered emergency, the Member must first pay all charges for the prescription, and then submit a completed Prescription Drug Claim Form noting “emergency request” on the form to Blue Shield Pharmacy Services -Emergency Claims, P.

  • However, if the Plan Participant must file a Claim to access his Prescription Drug Benefit, the Plan Participant must use the Prescription Drug Claim Form.

  • The Prescription Drug Claim Form, or an attachment acceptable to the Claims Administrator, may require the signature of the dispensing pharmacist.

  • To file Claims for Prescription Drug Benefits, You must use the Prescription Drug Claim Form or an attachment that We accept.

  • To file, You must use the Prescription Drug Claim Form and have Your pharmacist sign it (or an attachment that We accept).

  • Your program will not provide benefits if you use a non-network pharmacy within theBlue Open Access POS service area.You can obtain a Prescription Drug Claim Form by calling Client Services at 844-423-9988.You can file up to three prescriptions on each form.

  • The Prescription Drug Claim Form, or an attachment acceptable to Us, may require the signature of the dispensing pharmacist.

  • Your program will not provide benefits if you use a non-network pharmacy within the Blue Preferred Plus POS or Blue Preferred HMO service area.You can obtain a Prescription Drug Claim Form by calling Client Services at 888-811-2092.You can file up to three prescriptions on each form.

  • The itemized bill should be submitted to the PBM with a completed and signed Prescription Drug Claim Form.Members can obtain a copy of the Prescription Drug Claim Form by contacting Rx Member Services or visiting the Member link on Capital’s website at capbluecross.com.


More Definitions of Prescription Drug Claim

Prescription Drug Claim means a Member Submitted Claim or a claim
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Prescription Drug Claim means a Member Submitted Claim, Subrogation Claim, or claim for payment submitted by a Participating Pharmacy as a result of dispensing a Covered Drug to a Member.
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Prescription Drug Claim means a claim for payment submitted to Contractor by a Participating Pharmacy through Contractor’s claims processing system, or submitted by a Member, as a result of dispensing Prescription Drugs, Non-Drug Items, vaccine administration, or other covered benefits listed in the Benefit Plan Design.
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Prescription Drug Claim means an EGWP Enrollee Submitted Claim or claim for payment of a Covered Product submitted to Express Scripts by a Participating Pharmacy, Mail Service Pharmacy, or Specialty Pharmacy as a result of dispensing Covered Drugs to a EGWP Enrollee.
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Prescription Drug Claim means a claim submitted by a Member or pharmacy, whether submitted electronically or manually, for payment for a Covered Product.
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Prescription Drug Claim means an Enrollee Submitted Claim, a Medicaid Subrogation Claim or any other transaction submitted to ESI for payment or processing or other handling and which involves the dispensing of a Covered Drug to an Enrollee; a “generic claim” relates to the dispensing of a Generic Drug, a “brand claim” relates to the dispensing of a Brand Drug and a “specialty claim” relates to the dispensing of a Specialty Product.
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Related to Prescription Drug Claim

  • Prescription drug order means an original or new order from a practitioner for drugs, drug-related devices or treatment for a human or animal, including orders issued through collaborative care agreements. Lawful prescriptions result from a valid practitioner-patient relationship, are intended to address a legitimate medical need, and fall within the prescribing practitioner's scope of professional practice;

  • Prescription drug means any drug required by federal law or regulation to be dispensed only

  • Prescription drugs means drugs, medicine and controlled substances which by law can only be prescribed for human use by persons authorized by law.

  • Nonprescription drug or "over-the-counter drug" means any

  • Nonprescription drugs means nonnarcotic medicines or drugs which may be sold without a prescription and are prepackaged and labeled for use by the consumer in accordance with the requirements of the statutes and regulations of this state and the federal government;

  • Participating Prescription Drug Provider means an independent retail Pharmacy, chain of retail Pharmacies, mail-order Pharmacy or specialty drug Pharmacy which has entered into an agreement to provide pharmaceutical services to participants in the benefit program. A retail Participating Pharmacy may or may not be a select Participating Pharmacy as that term is used in the Vaccinations Obtained Through Participating Pharmacies section.

  • Drug abuse means any pattern of pathological use of drugs that causes impairment in social or occupational functioning, or that produces physiological dependency evidenced by physical tolerance or by physical symptoms when it is withdrawn.

  • Drug addiction means a disease characterized by a

  • Participating Clinical Laboratory means a Clinical Laboratory which has a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan to provide services to you at the time services are rendered.

  • Prescription device means an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, and any component part or accessory, which is required under federal or state law to be prescribed by a practitioner and dispensed by or through a person or entity licensed under this chapter or exempt from licensure under this chapter.

  • Non-Participating Clinical Laboratory means a Clinical Laboratory which does not have a written agreement with the Claim Administrator or another Blue Cross and/or Blue Shield Plan provide services to you at the time services are rendered.

  • New Drug Application means a new drug application in the United States for authorization to market a product, as defined in the applicable laws and regulations and submitted to the FDA.

  • Clinical laboratory means a facility for the microbiological, serological, chemical, hematological, radiobioassay, cytological, immunohematological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of a disease or assessment of a medical condition.

  • Phase III Clinical Trial means a human clinical trial of a product, the design of which is acknowledged by the FDA to be sufficient for such clinical trial to satisfy the requirements of 21 C.F.R. 312.21(c) (as amended or any replacement thereof), or a similar human clinical trial prescribed by the Regulatory Authority in a country other than the United States, the design of which is acknowledged by such Regulatory Authority to be sufficient for such clinical trial to satisfy the requirements of a pivotal efficacy and safety clinical trial.

  • Drug means (i) articles or substances recognized in the official United States Pharmacopoeia

  • Phase III Clinical Trials means a Clinical Trial for the Product on sufficient numbers of patients to generate safety and efficacy data to support Regulatory Approval in the proposed therapeutic indication, conducted in accordance with current good clinical practices and in accordance with a protocol that has been reviewed by the FDA and reflects any comments or concerns raised by the same.

  • Phase III Clinical Study means a trial involving administration of a Compound to sufficient numbers of human patients with the goal of establishing that the Compound is safe and efficacious for its intended use, to define warnings, precautions and adverse reactions that are associated with the drug or label expansion of such Compound, and to be considered as a pivotal study for submission of an NDA.

  • Phase I Clinical Trial means a human clinical trial that is intended to initially evaluate the safety and/or pharmacological effect of a Product in subjects or that would otherwise satisfy requirements of 21 C.F.R. 312.21(a), or its foreign equivalent.

  • Drug Master File or “DMF” is described in 21 C.F.R. Part 314.420. A DMF is a submission to the FDA that may be used to provide confidential detailed information about facilities, processes, or articles used in the manufacturing, processing, packaging, and storing of one or more human drugs.

  • FDA means the United States Food and Drug Administration and any successor agency thereto.

  • Phase 3 Clinical Trial means a pivotal clinical trial in humans performed to gain evidence with statistical significance of the efficacy of a product in a target population, and to obtain expanded evidence of safety for such product that is needed to evaluate the overall benefit-risk relationship of such product, to form the basis for approval of an NDA and to provide an adequate basis for physician labeling, as described in 21 C.F.R. § 312.21(c) or the corresponding regulation in jurisdictions other than the United States.

  • Phase I Clinical Study means a human clinical study of a product, the principal purpose of which is a preliminary determination of safety in healthy individuals or patients, as described in 21 C.F.R. 312.21(a).

  • Prescription means an order for drugs or medical supplies, written or signed or transmitted by word

  • Phase II Clinical Trial means a controlled human clinical study that would satisfy the requirements of 21 CFR 312.21(b), conducted to study the effectiveness and establish the dose range of a Product for a particular Indication in patients with the disease or condition under study, including a Phase IIA Clinical Study or Phase IIB Clinical Study.

  • Approved clinical trial means a phase I, phase II, phase III, or phase IV clinical trial that is conducted in relation to the prevention, detection, or treatment of cancer or other life-threatening disease or Condition and is described in any of the following:

  • Licensed clinical social worker means an individual who meets the licensed clinical social worker requirements established in KRS 335.100.