SCOPE OF WORK NETWORK ACCESS / PHARMACY DISTRIBUTION CHANNELS RETAIL PHARMACY NETWORK The Contractor is to perform the below requirements. The Contractor shall: Establish and maintain a network of Participating Pharmacies that have agreed to discount their charges for prescription drugs; Ensure that its PBM/Participating Pharmacy contracts satisfy all State and federal licensure, record-keeping, access and consumer protection requirements; Ensure that a minimum of 98.0% of all Members have an available Retail Pharmacy in the Pharmacy Network within the following radius of their residence: Urban: within 1.5 miles; Suburban: within 3 miles; and Rural: within 10 miles; Provide advance written notification to the SCM of any change in the Pharmacy Network that will affect a 1.0% or greater change in the number of Participating Pharmacies in the Pharmacy Network or a disruption that would impact 3.0% or greater of the Members in the SHBP/SEHBP. The Contractor shall ensure the written notice of change is provided to the SCM at least 45 Calendar Days prior to the change. The Contractor must provide the SCM, at the same time, with a list of the names of the Members that will be affected by the discontinuation; Provide a detailed written notification to the impacted Members of such network change as described in part D above. This shall be provided to the impacted Members at least 30 Calendar Days prior to the change. Notification to the Member shall include, but need not be limited to: Name of impacted pharmacy; Name of alternate pharmacy; Distance to alternate pharmacy; Address of alternate pharmacy; Phone number of alternate pharmacy; and Directions on how to move prescriptions to alternate pharmacy. Provide the State with improved discount guarantees for the retail 30 brand and retail 30 generic pricing guarantees, and reporting, if the number of Participating Pharmacies in the Pharmacy Network is reduced by more than 3.0% before the effective date or any point during the term of the Contract. This offer shall be provided to SCM at least 90 Calendar Days prior to the effective date of the change. The reduction in network size must be approved in writing by the SCM; and Ensure that Retail Pharmacy Claims are paid within 30 Calendar Days of receipt by the PBM. RETAIL PHARMACY 90-DAY NETWORK The Contract shall perform the below requirements in relation to the Retail Pharmacy 90-day Network. The Contractor shall: Have a network of pharmacies to dispense 90-day supplies of maintenance medications; Maintain a network of pharmacies that have agreed to discount their charges for 90-day supplies of prescription drugs; Ensure that the 90-day Retail Pharmacy contracts satisfy all State and federal licensure, record-keeping, access and consumer protection requirements; Ensure that a minimum of 98.0% of all Members have an available Retail Pharmacy in the Pharmacy Network within a ten (10) mile radius of their residence; Provide advance written notification to the State of any change in the Retail Pharmacy 90-Day Network that will affect a 1.0% or greater change in the number of Participating Pharmacies in the Retail Pharmacy 90-Day Network or a disruption that would impact 3.0% or greater of the Members in the SHBP/SEHBP. The Contactor shall ensure the written notice of change is provided to the SCM at least 45 Calendar Days prior to the change. The Contractor must provide the State, at the same time, with a list of the names of the Members that will be affected by the discontinuation; Provide a detailed written notification to the impacted Members of such network change. This shall be provided to the impacted Members at least 30 Calendar Days prior to the change. Notification to the Member shall include but need not be limited to: Name of impacted pharmacy; Name of alternate pharmacy; Distance to alternate pharmacy; Address of alternate pharmacy; Phone number of alternate pharmacy; and Directions on how to move prescriptions to alternate pharmacy; and Provide the State with improved discount guarantees for the retail 90 brand and retail 90 generic pricing guarantees if the number of Participating Pharmacies in the Retail Pharmacy 90-Day Network is reduced by more than 3.0% before the effective date or any point during the term of the Contract. This offer shall be provided at least 90 Calendar Days prior to the effective date of the change. The reduction in network size must be approved in writing by the SCM; and Ensure that Retail 90 day Pharmacy Claims are paid within 30 Calendar Days of receipt by the PBM. MAIL ORDER PHARMACY The Contractor shall, in conjunction with the Mail Order Pharmacy: Ensure at least 95.0% of all Non-Protocol Prescriptions are dispensed within two (2) Business Days following receipt of the prescription by the Contractor;
