The CONTRACTOR shall submit the following information to the DEPARTMENT, in the format as determined by the DEPARTMENT, for inclusion in the communications from the DEPARTMENT for the period: IT’S YOUR CHOICE OPEN ENROLLMENT CONTRACTOR information, including address, toll-free customer service telephone number, and website address. content for the pharmacy benefit related information page, CONTRACTOR’s including available features. Information for PARTICIPANTS to access the pharmacy CONTRACTOR’s network directory on its web site, including a link to the pharmacy network directory. The CONTRACTOR shall submit all informational materials intended for distribution to PARTICIPANTS during the period to the IT’S YOUR CHOICE OPEN ENROLLMENT DEPARTMENT for review and approval. The CONTRACTOR shall submit three (3) hard copies of all YOUR CHOICE OPEN IT’S ENROLLMENT materials in final format to the DEPARTMENT at least two (2) weeks prior to the start of the period. IT’S YOUR CHOICE OPEN ENROLLMENT 135C Required Member and Prescriber Outreach When making any changes to the formulary, the CONTRACTOR will be required to send notification a minimum 90 days prior to the change to all PARTICIPANTS who are currently prescribed drugs affected by the change. The notification should include the drug affected, the tier/cost-share level of the drug prior to change, the tier/cost-share level of the drug after change, the cost difference, contact information for the customer service, and CONTRACTOR’s information on rights to appeal. This does not preclude the CONTRACTOR from members’ implementing the formulary change immediately for PARTICIPANTS who have a new prescription written for the affected drug. The CONTRACTOR will also be required to contact PRESCRIBERS and PARTICIPATING PHARMACIES to notify these organizations of formulary change. Notification should be made no less than 90 days prior to the change in formulary. 140 Information Systems The systems must have the capability of adapting to any future changes CONTRACTOR’S that become necessary as a result of modifications to the state and LOCAL programs and their requirements. The systems shall be scalable and flexible so they can CONTRACTOR’S be adapted as needed, within negotiated timeframes, as requirements may change. If the CONTRACTOR has plans to migrate to a different data or web platform, the DEPARTMENT must be notified no less than six (6) months in advance of the migration.
The CONTRACTOR shall submit the following information to the DEPARTMENT, in the format as determined by the DEPARTMENT, for inclusion in the communications from the DEPARTMENT for the IT’S YOUR CHOICE OPEN ENROLLMENT period: CONTRACTOR information, including address, toll-free customer service telephone number, and website address. CONTRACTOR’s content for the pharmacy benefit related information page, including available features. Information for PARTICIPANTS to access the CONTRACTOR’s pharmacy network directory on its web site, including a link to the pharmacy network directory. The CONTRACTOR shall submit all informational materials intended for distribution to PARTICIPANTS during the IT’S YOUR CHOICE OPEN ENROLLMENT period to the DEPARTMENT for review and approval. The CONTRACTOR shall submit three (3) hard copies of all IT’S YOUR CHOICE OPEN ENROLLMENT materials in final format to the DEPARTMENT at least two (2) weeks prior to the start of the IT’S YOUR CHOICE OPEN ENROLLMENT period. 135C Required Member and Prescriber Outreach When making any changes to the formulary, the CONTRACTOR will be required to send notification a minimum 90 days prior to the change to all PARTICIPANTS who are currently prescribed drugs affected by the change. The notification should include the drug affected, the tier/cost-share level of the drug prior to change, the tier/cost-share level of the drug after change, the cost difference, contact information for the CONTRACTOR’s customer service, and information on members’ rights to appeal. This does not preclude the CONTRACTOR from implementing the formulary change immediately for PARTICIPANTS who have a new prescription written for the affected drug. The CONTRACTOR will also be required to contact PRESCRIBERS and PARTICIPATING PHARMACIES to notify these organizations of formulary change. Notification should be made no less than 90 days prior to the change in formulary. 140 Information Systems The CONTRACTOR’S systems must have the capability of adapting to any future changes that become necessary as a result of modifications to the state and LOCAL programs and their requirements. The CONTRACTOR’S systems shall be scalable and flexible so they can be adapted as needed, within negotiated timeframes, as requirements may change. If the CONTRACTOR has plans to migrate to a different data or web platform, the DEPARTMENT must be notified no less than six (6) months in advance of the migration.
Exhibit1_PBP_Agreement_Rev.docx