Dispensing and Monitoring Requirements Sample Clauses

The Dispensing and Monitoring Requirements clause sets out the obligations and procedures for distributing and overseeing the use of certain products, typically pharmaceuticals or controlled substances. It details how items must be dispensed, who is authorized to dispense them, and the record-keeping or reporting standards that must be followed to track their use. This clause ensures that products are handled safely and in compliance with legal or regulatory standards, thereby minimizing misuse and supporting accountability.
Dispensing and Monitoring Requirements. The Contractor shall administer pharmacy benefits in accordance with all applicable state and federal laws and regulations. The Contractor shall comply with the requirements of IC 12-15-35.5-3 in establishing prescribing limits to mental health drugs. For any drugs which require prior authorization, the Contractor shall provide a response by telephone or other telecommunication device within twenty-four (24) hours of a request for prior authorization. Additionally, the Contractor shall provide for the dispensing of at least a seventy-two (72) hour supply of a covered outpatient prescription drug in an emergency situation as required under 42 U.S.C 1396r- 8(d)(5)(B). The Contractor shall employ an automated system for approval of a seventy-two (72) hour emergency supply of a restricted drug. The automated system shall allow the pharmacist to dispense the seventy-two (72) hour supply and then follow-up with the Contractor or provider the next business day. The Contractor, implementing a unified PDL, shall implement prior authorization approved for all plans, by the DUR Board. The Contractor shall participate in the development and recommendation of PA criteria brought before the DUR Board. If it elects to utilize its own PA process, the Contractor may require prior authorization requirements, such as general member information, a justification of need for drug related to the medical needs of the member and a planned course of treatment, if applicable, as related to the number drug provided and duration of treatment. The Contractor will be required to have a process in place to allow drugs that are medically necessary but not included on the formulary to be accessed by members. The Contractor will be required to accept prior authorization requests via telephone, fax, web-based system, or in writing. The Contractor shall provide online and real-time rules-based point-of-sale (POS) claims processing for pharmacy benefits. The Contractor shall maintain prospective drug utilization review edits and apply these edits at the POS. Independently developed and implemented PA criteria will be displayed, in a common format, alongside fee for service and other Contractor criteria. Additionally, the Contractor shall implement retrospective drug use review to identify patterns of fraud, abuse, gross overuse, or inappropriate or medically unnecessary care, among physicians, pharmacists and individuals receiving benefits, or associated with specific drugs or groups of drugs....
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Dispensing and Monitoring Requirements. The Contractor shall administer pharmacy benefits in accordance with all applicable state and federal laws and regulations. For any drugs which require prior authorization, the Contractor shall provide a response by telephone or other telecommunication device within twenty -four
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Dispensing and Monitoring Requirements. The Contractor shall administer pharmacy benefits in accordance with all applicable state and federal laws and regulations. For any drugs which require prior authorization, the Contractor shall provide a response by telephone or other telecommunication device within twenty-four (24) hours of a request for prior authorization. Additionally, the Contractor shall provide for the dispensing of at least a seventy-two (72) hour supply of a covered outpatient prescription drug in an emergency situation as required under 42 U.S.C 1396r- 8(d)(5)(B). The Contractor shall comply with the requirements of IC 12-15- 35.5-3 in establishing prior authorization requirements for mental health drugs. The Contractor may require prior authorization requirements, such as general member information, a justification of need for drug related to the medical needs of the member and a planned course of treatment, if applicable, as related to the number drug provided and duration of treatment. The Contractor will be required to have a process in place to allow drugs that are medically necessary but not included on the formulary to be accessed by members. The Contractor shall provide online and real-time rules-based point-of-sale (POS) claims processing for pharmacy benefits. The Contractor shall maintain prospective drug utilization review edits and apply these edits at the POS. These criteria and edits must be reviewed and approved by the DUR Board prior to implementation. Additionally, the Contractor shall implement a retrospective drug utilization program to analyze for drugs or specific groups of drugs to document utilization trends and intervene with identified prescriber practice outliers leading to educational interventions which emphasize clinically sound and cost effective care. The Contractor must also implement a program to identify and report fraud and abuse among providers and members.
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Dispensing and Monitoring Requirements. The Contractor shall administer pharmacy benefits in accordance with all applicable state and federal laws and regulations. For any drugs which require prior authorization, the Contractor shall provide a response by telephone or other telecommunication device within twenty-four (24) hours of a request for prior authorization. Additionally, the Contractor shall provide for the dispensing of at least a seventy-two (72) hour Emergency EXHIBIT 1 SCOPE OF WORK supply of a covered outpatient prescription drug, as required under 42 U.S.C 1396r- 8(d)(5)(B), without prior authorization. The Contractor may require prior authorization requirements, such as general member information, a justification of need for drug related to the medical needs of the member and a planned course of treatment, if applicable, as related to the quantity of drug provided and duration of treatment. The Contractor will be required to have a process in place to allow member access to medically necessary non-preferred (non-formulary) drugs. To conform to 42 CFR 437-438.3(s) and the Medicaid and CHIP Managed Care Final Rule (CMS-2390-F), once universal medically necessary prior authorization criteria for access to a prescription drug is developed, the Contractor’s criteria must be consistent with the amount, duration and scope of that criteria and may not be more stringent. The Contractor shall provide online and real-time rules-based point-of-sale (POS) claims processing for pharmacy benefits. The Contractor shall maintain prospective drug utilization review edits and apply these edits at the POS. These criteria and edits must be reviewed and approved by the DUR Board prior to implementation. The Contractor shall maintain prospective drug utilization review criteria and edits for covered outpatient drugs that the Contractor limits to medical benefit coverage. All criteria and edits applied to covered outpatient drugs for the pharmacy benefit and/or the medical benefit will be posted online, linked to the ▇▇▇▇▇://▇▇▇.▇▇.▇▇▇/medicaid/ website. Additionally, the Contractor shall implement a retrospective drug utilization program to analyze for drugs or specific groups of drugs to document utilization trends and intervene with identified prescriber practice outliers leading to educational interventions which emphasize clinically sound and cost-effective care. The Contractor must also implement a program to identify and report fraud and abuse among providers and members.
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Dispensing and Monitoring Requirements. 54 3.8.5 E-Prescribing 55 3.8.6 Carve-Out of Select Drugs 55 3.8.7 340B 56 3.8.8 Pharmacy Continuity of Care 56 3.8.9 SUPPORT Act Compliance 56 3.9 Smoking Cessation and Tobacco Dependence Treatment 57 3.10 Behavioral Health Services 57 3.10.1 Identification of Behavioral Health Care Needs 59 3.10.2 Behavioral Health Care Coordination 60 3.10.3 Behavioral Health Continuity of Care 61 3.10.4 Institution for Mental Disease (IMD) 62 3.11 Dental Services 63 3.12 Inpatient Hospitalization Notification 63 3.13 Carved-Out Services 63 3.13.1 Medicaid Rehabilitation Option (MRO) Services 64 3.13.2 1915(i) State Plan Home and Community-Based Services 64 3.13.3 Individualized Family Services Plan (IFSP) 64 3.13.4 Individualized Education Plan (IEP) Services 64 3.13.5 Carved Out Drug Classes 64 3.14 Excluded Services 65 3.14.1 Long-Term Institutional Care 65 3.14.2 Psychiatric Treatment in a State Hospital 65 3.14.3 Psychiatric Residential Treatment Facility (PRTF) Services 65 3.14.4 Intermediate Care Facilities for Individuals with Intellectual Disabilities 66 3.14.5 Home and Community-Based Services (HCBS) 66 3.15 Continuity of Care 66 3.16 Out-of-Network Services 67 3.16.1 Directed Payment for Eligible Out-of-State Children’s Hospitals 67 3.17 Enhanced Services 69 3.18 Opioid Treatment Program (OTP) 70 3.19 Non-Emergency Medical Transportation Services 71 3.20 Residential Substance Use Disorder (SUD) Services 71 3.21 Hospice Services 72 4.1 Marketing and Outreach 72 4.2 Member Enrollment and Contractor Selection 73 4.3 Enrollment and Practice Discrimination 74 4.4 Enrollment Packet 75 4.4.1 Provider Network Information 75 4.4.2 Member Handbook 76 4.4.3 Member ID Card 80 4.5 Member Disenrollment 80 4.6 Member-Contractor Communications 81 4.6.1 Member Services Helpline and 24 Hour Nurse Line 82 4.6.2 Electronic Communications 84 4.7 Member Information, Education and Outreach 85 4.7.1 Member and Stakeholder Education and Engagement 85 4.7.2 General Member Information Requirements 86 4.7.3 Additional Information Available Upon Request 87 4.7.4 Oral Interpretation Services 90 4.7.5 Health Equity 90 4.7.6 Advance Directive Information 92 4.7.7 Member Website 93 4.7.8 Preventive Care Information 94 4.7.9 Cost and Quality Information 94 4.7.10 Member Education 95 4.8 Member-Provider Communications 95 4.9 Member and Potential Member Communications Review and Approval 96 4.10 Member Rights 96 4.11 Redetermination Assistance 97 4.12 Member Inquiries, Grievances & Appeals 98 4...
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Dispensing and Monitoring Requirements. 54 3.8.5 E-Prescribing 55 3.8.6 Carve-Out of Select Drugs 55 3.8.7 340B 55 3.8.8 Pharmacy Continuity of Care 56 3.8.9 SUPPORT Act Compliance 56 3.9 Smoking Cessation and Tobacco Dependence Treatment 57 3.10 Behavioral Health Services 57 3.10.1 Identification of Behavioral Health Care Needs 59 3.10.2 Behavioral Health Care Coordination 59 3.10.3 Behavioral Health Continuity of Care 61 3.10.4 Institution for Mental Disease (IMD) 62 3.11 Dental Services 63 3.12 Inpatient Hospitalization Notification 63 3.13 Carved-Out Services 63 3.13.1 Medicaid Rehabilitation Option (MRO) Services 64 3.13.2 1915(i) State Plan Home and Community-Based Services 64 3.13.3 Individualized Family Services Plan (IFSP) 64 3.13.4 Individualized Education Plan (IEP) Services 64 3.13.5 Carved Out Drug Classes 64 3.14 Excluded Services 64 3.14.1 Long-Term Institutional Care 65 3.14.2 Psychiatric Treatment in a State Hospital 65 3.14.3 Psychiatric Residential Treatment Facility (PRTF) Services 65 3.14.4 Intermediate Care Facilities for Individuals with Intellectual Disabilities 65 3.14.5 Home and Community-Based Services (HCBS) 66 3.15 Continuity of Care 66 3.16 Out-of-Network Services 67 3.16.1 Directed Payment for Eligible Out-of-State Children’s Hospitals 67 3.17 Enhanced Services 68 3.18 Opioid Treatment Program (OTP) 70
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Related to Dispensing and Monitoring Requirements

  • Monitoring Requirements This Schedule sets out the contract management requirements which are applicable to the delivery of the Services.

  • Reporting and Monitoring Please provide a brief description of the mechanisms proposed for this project for reporting to the UNDP and partners, including a reporting schedule.

  • Credentialing Requirements Registry Operator, through the facilitation of the CZDA Provider, will request each user to provide it with information sufficient to correctly identify and locate the user. Such user information will include, without limitation, company name, contact name, address, telephone number, facsimile number, email address and IP address.

  • Trunking Requirements The Parties will provide designed Interconnection facilities that meet the same technical criteria and service standards, such as probability of blocking in peak hours and transmission standards, in accordance with current industry standards.

  • Monitoring and Compliance Every year during the term of this Agreement on the anniversary date of the effective date of the Agreement, the Restaurant shall provide to the United States a narrative report of the actions taken during the reporting period to remove any barriers to access and otherwise enhance accessibility for individuals with disabilities at the Restaurant and any plans for action concerning ADA compliance in the coming year. The report shall include as an exhibit copies of any complaint, whether formal or informal, received during the reporting period alleging that the Restaurant was not being operated in compliance with the ADA or otherwise discriminated against any person on account of disability. The Owner and Operator of the Restaurant shall cooperate in good faith with any and all reasonable requests by the United States for access to the Restaurant and for information and documents concerning the Restaurant's compliance with this Agreement and the ADA. The United States shall have the right to verify compliance with this Agreement and the ADA, both as set forth in this Agreement and through any means available to the general public, including visits to the public areas of the Restaurant and communications with Restaurant staff. The United States shall have the right to inspect the facility at any time, and counsel for the United States need not identify themselves in the course of visits to the public areas.