BHS PROGRAM Sample Clauses

The BHS PROGRAM clause defines the terms and conditions governing participation in a specific program, likely related to health, safety, or benefits within an organization. It typically outlines eligibility requirements, the scope of services or benefits provided, and the responsibilities of both the program administrators and participants. For example, it may specify who can enroll, what procedures must be followed, and what support or resources are available. The core function of this clause is to establish clear guidelines for program operation, ensuring that all parties understand their roles and the benefits or obligations involved.
BHS PROGRAM. RX BENEFIT DESIGN 20 1. CONTRACTOR shall reimburse only those medications that are on the BHS Program 21 formulary which shall be developed and maintained by the BHS Program. The COUNTY, through the 22 BHS Program is the payer of last resort for medically necessary medications in the treatment of mental 23 illness prescribed by Authorized BHS Program Prescribers. BHS Program maintains a formulary 24 restricted to generic formulations when they are available. 25 2. The ADMINISTRATOR or the PBM Auditor shall provide the BHS Program Formulary 26 and any modifications thereafter to CONTRACTOR. For reference only, the most current BHS 27 Program Formulary should be posted by the ADMINISTRATOR on the BHS website at: 28 ▇▇▇▇://▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇/bhs/about/formulary. 29 3. In order to ensure that therapeutic integrity is maintained in the face of cost considerations, 30 only generics rated as therapeutically equivalent (so-called “A” or “AB rated”), or rated equivalent to 31 the pioneer product by the FDA are covered. 32 4. ADMINISTRATOR, in rare cases, may cover a non-formulary drug when approved in 33 writing by the ADMINISTRATOR. 34 5. CONTRACTOR agrees that reimbursement of any medications authorized outside the 35 scope of the BHS Program formulary, without a proper prior authorization from the 36 ADMINISTRATOR, will result in an audit exception and funds withheld from CONTRACTOR in 37 accordance with Exhibit D to the Agreement. 1 6. CONTRACTOR agrees that all medications must be provided by the Network of 2 Pharmacies provided by the CONTRACTOR. CONTRACTOR shall provide its Pharmacy Benefits 3 Management services based on the following BHS Program guidelines. Failure to do so without proper 4 authorization from the ADMINISTRATOR will result in an audit exception and funds withheld from 5 CONTRACTOR in accordance with Exhibit C to this Agreement. 6 7. CONTRACTOR agrees that all medications available in generic formulations must be 7 prescribed as generic. If a physician prescribes a brand name product, then the pharmacy is expected to 8 substitute with a generic formulation when one is available unless a prior authorization is provided by 9 ADMINISTARTOR to the CONTRACTOR. 10 8. CONTRACTOR agrees that all medications on the formulary have a quantity limit on the 11 number of units covered in a month’s supply, and a dollar limit on the maximum payment that BHS will 12 approve. These quantity limits and maximum dollar thresholds are formulary limits on the usual ...
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BHS PROGRAM. 1. Act as a liaison between the PBM and BHS Program, as necessary, for day-to-day questions, concerns, or operational issues; 2. Establish Clinical Practice Guidelines/Best Practices Development for the MRC; 3. As requested by County, personally attend meetings when deemed necessary; and 4. Periodic financial review of BHS Program expenditures, invoice analyses, and any discrepancies noted.
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BHS PROGRAM. PHARMACY NETWORK MANAGEMENT 34 1. CONTRACTOR shall distribute informational materials to the Participating Pharmacies if 35 the BHS Program plan design changes or other network changes are made. Such communications shall 36 be approved by ADMINISTRATOR before distribution to the Participating Pharmacies. 37 // 1 2. CONTRACTOR shall routinely communicate, upon approval of the ADMINISTRATOR, 2 policies and procedures regarding new drugs, therapeutic substitution, utilization management, and 3 adjudication standards and practices (particularly relating to coordination of benefits) to pharmacies in 4 the network. 5 3. CONTRACTOR agrees that any communications referencing the BHS Program shall be 6 approved by the ADMINISTARTOR, including educational materials, before any materials are 7 distributed to the pharmacy network. Educational materials that may be specifically related to the BHS 8 Program include: 9 a. Formulary and preferred drug lists; 10 b. Policies & procedures related to claims submission; 11 c. New product notifications; 12 d. Communication of new clinical guidelines; 13 e. Policies & procedures related to prior authorizations; 14 f. Patient compliance reminders; 15 g. MAC program details; 16 h. Policies & procedures related to member grievances; and 17 i. Benefits of optimizing generic drugs 18 4. CONTRACTOR shall manage Participating Pharmacy relationships, including 19 credentialing and contracting, which encompasses pharmacy program compliance, contractual disputes, 20 and re-credentialing. 21 a. CONTRACTOR may be requested by the ADMINISTRATOR to go into local areas to 22 better communicate with and educate pharmacists on issues that directly impact the BHS Clients being 23 served. 24 b. CONTRACTOR shall periodically survey pharmacies in order to better monitor the 25 satisfaction and needs of network pharmacies and shall share the results of these surveys with
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BHS PROGRAM. PHARMACY NETWORK MANAGEMENT 34 1. CONTRACTOR shall distribute informational materials to the Participating Pharmacies if 35 the BHS Program plan design changes or other network changes are made. Such communications shall 36 be approved by ADMINISTRATOR before distribution to the Participating Pharmacies. 37 // 1 2. CONTRACTOR shall routinely communicate, upon approval of the ADMINISTRATOR, 2 policies and procedures regarding new drugs, therapeutic substitution, utilization management, and 3 adjudication standards and practices (particularly relating to coordination of benefits) to pharmacies in 4 the network. 5 3. CONTRACTOR agrees that any communications referencing the BHS Program shall be 6 approved by the ADMINISTARTOR, including educational materials, before any materials are 7 distributed to the pharmacy network. Educational materials that may be specifically related to the BHS 8 Program include: 9 a. Formulary and preferred drug lists; 10 b. Policies & procedures related to claims submission; 11 c. New product notifications; 12 d. Communication of new clinical guidelines; 13 e. Policies & procedures related to prior authorizations; 14 f. Patient compliance reminders; 15 g. MAC program details; 16 h. Policies & procedures related to member grievances; and 17 i. Benefits of optimizing generic drugs
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Related to BHS PROGRAM

  • Educational Program A. DSST PUBLIC SCHOOLS shall implement and maintain the following characteristics of its educational program in addition to those identified in the Network Contract at DSST ▇▇▇▇ MIDDLE SCHOOL (“the School” within Exhibit A-3). These characteristics are subject to modification with the District’s written approval:

  • HEALTH PROGRAM 3701 Health examinations required by the Employer shall be provided by the Employer and shall be at the expense of the Employer. 3702 Time off without loss of regular pay shall be allowed at a time determined by the Employer for such medical examinations and laboratory tests, provided that these are performed on the Employer’s premises, or at a facility designated by the Employer. 3703 With the approval of the Employer, a nurse may choose to be examined by a physician of her/his own choice, at her/his own expense, as long as the Employer receives a statement as to the fitness of the nurse from the physician. 3704 Time off for medical and dental examinations and/or treatments may be granted and such time off, including necessary travel time, shall be chargeable against accumulated income protection benefits.

  • The Program The Program is a comprehensive commercial energy efficiency program that offers financial incentives and financing for qualifying energy efficiency measures in commercial buildings to customers who are property owners, tenants or managers (customers) of ACE in New Jersey. Customers must receive ACE electric delivery service and be in good standing. Incentives are available to customers for the purchase and installation of qualifying energy-efficiency measures at the location where the qualifying project is to be installed. ▇▇▇ will not offer financial incentives for the same eligible measure to those customers who have received financial incentives or rebates from other ACE energy efficiency programs.

  • Safety Program The Contractor shall design a specific safety program for the Work for the site(s). The Contractor shall establish and require all Subcontractors to establish reasonable safety programs. The Contractor shall also submit its standard monthly safety reports to the Owner and Design Professional. No imposition of responsibility on the Contractor for safety under this Contract shall relieve any subcontractor of its responsibility for safety of persons or property on or near the Project Site. The Contractor shall include in his plant he names of the person in charge of Safety.

  • Commercialization Plan On a Product by Product basis, not later than sixty (60) days after the filing of the first application for Regulatory Approval of a Product in the Copromotion Territory, the MSC shall prepare and approve a rolling multiyear (not less than three (3) years) plan for Commercializing such Product in the Copromotion Territory (the "Copromotion Territory Commercialization Plan"), which plan includes a comprehensive market development, marketing, sales, supply and distribution strategy for such Product in the Copromotion Territory. The Copromotion Territory Commercialization Plan shall be updated by the MSC at least once each calendar year such that it addresses no less than the three (3) upcoming years. Not later than thirty (30) days after the filing of the first application for Regulatory Approval of a Product in the Copromotion Territory and thereafter on or before September 30 of each calendar year, the MSC shall prepare an annual commercialization plan and budget (the "Annual Commercialization Plan and Budget"), which plan is based on the then current Copromotion Territory Commercialization Plan and includes a comprehensive market development, marketing, sales, supply and distribution strategy, including an overall budget for anticipated marketing, promotion and sales efforts in the upcoming calendar year (the first such Annual Development Plan and Budget shall cover the remainder of the calendar year in which such Product is anticipated to be approved plus the first full calendar year thereafter). The Annual Commercialization Plan and Budget will specify which Target Markets and distribution channels each Party shall devote its respective Promotion efforts towards, the personnel and other resources to be devoted by each Party to such efforts, the number and positioning of Details to be performed by each Party, as well as market and sales forecasts and related operating expenses, for the Product in each country of the Copromotion Territory, and budgets for projected Pre-Marketing Expenses, Sales and Marketing Expenses and Post-Approval Research and Regulatory Expenses. In preparing and updating the Copromotion Territory Commercialization Plan and each Annual Commercialization Plan and Budget, the MSC will take into consideration factors such as market conditions, regulatory issues and competition.