Library: Policy

317:30-5-180.1. Definitions

Issued 2-1-07

     The following words and terms, when used in this Part, have the following meaning, unless the context clearly indicates otherwise:

     "Enrollment Fee" means the amount charged per individual to enroll in the OPDDP.

     "Network" means a group of individual retail pharmacies that contract with the designated Pharmacy Benefit Manager to participate in the OPDDP and honor the discount offered through this program.

     "Patient Assistance Programs (PAP)" means a program that some pharmaceutical companies use to offer medication assistance to low-income individuals and families.  These programs typically require a doctor's consent and proof of financial status.  They may also require the individual applying for their program either have no health insurance, or no prescription drug benefit through their health insurance.  Each pharmaceutical company has specific eligibility requirements and application information.  Neither OHCA nor the contracted PBM have any authority or responsibility for the structure of these private programs.

     "Pharmacy Benefit Manager (PBM)" means the company contracted by OHCA to manage pharmacy networks, formularies, drug utilization reviews, pharmacotherapeutic outcomes, claims and/or other features of a pharmacy benefit.

     "Prescription Drug" means a drug which can be dispensed only upon prescription by a health care professional authorized by his or her licensing authority and which is approved for safety and effectiveness as a prescription drug under Section 505 or 507 of the Federal Food, Drug and Cosmetic Act (52 Stat. 1040 (1938), 21 U.S.C.A., Section 301).

     "Prescription Drug Coverage" means a payment or discount applied toward prescription drugs purchased by or for a consumer as part of a health insurance benefit.