BACKGROUND. ASES’ contract with the MCOs stipulates that certain medications, not otherwise covered under MI Salud, might be covered through an exception process by which the patient’s health care provider must substantiate the clinical need for such exception. Preferred and non-preferred medications covered by MI Salud are included in the FMC, though different levels of cost-sharing may apply. In addition, MI Salud has developed, through its Pharmacy & Therapeutics (P&T) Committee, a List of Medications by Exception (LME) that may be covered under special circumstances. The medications in the LME will be subject to the MCO’s evaluation upon the participating physician’s request for exception, on a case-by-case basis, to determine if it complies with the protocol established by ASES for said medication. If it is not in compliance, the medication will be denied; and if it complies, it will be approved. Medications not included in the FMC will be not be paid for by MI Salud unless an Exception Request is granted. If an Exception Request is submitted, drugs listed on the LME will be preferred over non-FMC drugs or LME covered outpatient drugs. An Exception Request may also be used to bypass certain utilization management restrictions applicable to drugs that are listed on the FMC, such as a step therapy requirement, quantity or dose limit, or prior authorization requirement. A patient may appeal a decision to deny an Exception Request. Certain drugs are considered excluded from coverage and will not be paid for by MI Salud even if an Exception Request is submitted. For example, under Section 1927(d)(2) of the Social Security Act, MI Salud will not cover drugs used to promote fertility, drugs used for cosmetic purposes or hair growth, drugs used for the symptomatic relief of cough and colds, most prescription vitamins and mineral products, non-prescription drugs or over-the counter-medication unless specifically included in MI Salud coverage, and drugs which the manufacturer seeks to require as a condition of sale that associated tests or monitoring services be purchased exclusively from the manufacturer or its designee. Drugs that are not prescribed for a medically accepted indication are also excluded and will not be covered. These drugs are considered “statutorily excluded.” Also excluded are drugs prescribed for the purpose of treating a condition not covered under MI Salud. In addition, the Puerto Rico Medicaid State Plan excludes certain drugs such as those to treat...
BACKGROUND. The coastline of the Pacific Central American Large Marine Ecosystem (PaCA LME) has a rich diversity of ecosystems. However, with more than half of the population living on the Pacific coast (in the case of Central America over 70%), environmental pressures are significant. The ecosystem is under stress from various sources including sewage and agrochemical run-off. The steep topography translates into high sedimentation rates, especially from landscapes eroded by poor agricultural practices. With the Panama Canal, the region is an important shipping route, with associated risks including oil pollution and ballast water invasive species. The rapid development of coastal areas (particularly for aquaculture and tourism) leads to removal or fragmentation of key habitats and to loss of, or threats to, biological diversity, as well as to the sustainability of human activities themselves. Fisheries trends over the past years indicate a decrease in catch, and some commercial species of importance to coastal communities appear to be overexploited. The sea area adjacent to this coastline is one of the least understood regions of the Pacific Ocean but supports important and unique transboundary biological sub-systems as well as key economic activities. The subsystems are dynamically connected within what can best be described as a large marine ecosystem. Economic activities in the region are expanding however, to the point that they represent a tangible threat to the integrity of the sub-systems and the LME as a whole. The region is also vulnerable to periodic ENSO (El Nino- Southern Oscillation) events and is one of the regions where hurricanes originate. Both phenomena are sensitive to climate change. During the Fourth Replenishment of the GEF most of the countries sharing this LME endorsed a proposal to be submitted for GEF financing through UNDP. Due to lack of funds during GEF 4 and part of GEF 5, the proposal is now planned to be submitted for the GEF 6 through UNDP, WWF and UNEP. These agencies are in search of a competent independent consultant with experience in developing projects to GEF specifications to assist the participating countries.
BACKGROUND. Peru and the United States share a long history of development cooperation that spans more than five decades, a period during which Peru has made tremendous progress. The United States Government (USG) has directly supported the Government of Peru (GOP) to attain notable achievements that include reduced maternal and infant mortality rates, more effective and accountable democratic institutions, and sustained, robust economic growth. The challenge in the current stage of USAID assistance is to consolidate and sustain Peru’s development progress through targeted cooperation, in order to further the partnership between the two countries and to define new roles in the evolving international scenario. Peru’s democratic and economic achievements in the last 15 years make it one of the strongest examples in Latin America of how a democratic, lower-income country can emerge from poverty through trade-led growth, sound macroeconomic policies, and responsible environmental stewardship. The country has undergone four orderly presidential transitions, and is in the midst of a major decentralization and modernization effort aimed at strengthening its democratic system. Despite the world financial crisis of 2008, Peru has logged over 15 consecutive years of positive economic growth. Strong international reserves evidence Peru’s macroeconomic stability and ability to defend its currency and maintain high investment ratings. Nonetheless, despite such overall progress, many Peruvian men and women—particularly outside of the coastal urban areas—have yet to see tangible benefits from these advances. Many receive few or inadequate basic governmental services and have not seen their incomes increase commensurate with the country’s growing economy. This perceived disparity between the economic boom of the coastal areas and continued poverty and ineffective governance in mountain and jungle regions has fostered a sense of social exclusion and division. A perception that the benefits from exploitation of natural resources have been inequitably distributed has led some to resort to social conflict to have their voices heard. Others, with limited economic opportunities and little trust in government, have resorted to illegal and/or environmentally hazardous livelihoods. Under the previous GOP administration from 2011 to 2016, the GOP demonstrated its political will to consolidate democracy and pursue equitable economic growth with a vision of social and economic inclusion. USAID i...
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