group health plans.
Southern Scripts uses a straight‐forward and clear cut methodology in all pricing. The retail brand/generic discount is purely based on the stated discount off of Average Wholesale Price (AWP). We do not use any other components to determine the retail brand/generic discount. Additionally, we invoke Maximum Allowable Cost (MAC) pricing in cases where it will produce a more favorable result over the stated retail generic discount.
Mail order service is an available option for members. Mail order will be made available but is NOT encouraged or actively promoted to members. As an alternative to mail order, Southern Scripts highly encourages the use of the 90‐Day Retail Network rates. The Plan Sponsor may choose to eliminate the mail order option from its plan design.
Southern Scripts will make every effort to ensure that no pharmacy (mail or retail) is being reimbursed on any NDC other than the original manufacturer's NDC. Southern Scripts will make every effort to prospectively deny claims for "repackaged" NDCs. Because mail order pharmacies may have business practices that avert these efforts, mail order will not be encouraged. Additionally, Southern Scripts will only partner with a select few mail order pharmacies who follow reputable business practices and allow close scrutiny of these practices by Southern Scripts.
Southern Scripts will handle adjudication of all prescription claims including specialty pharmacy items. Specialty drugs will only be available to members through Preferred Network pharmacies or our Specialty Pharmacy Partner. Any Specialty Pharmacy that meets our quality standards may contract through our Preferred Network. The pharmacy provider must agree to provide all supplies required to administer the drug to the patient and not charge any additional shipping fees. Southern Scripts does not limit a member's choice of Specialty Pharmacy provider, but does encourage use of its Specialty Pharmacy Partner. Our Specialty Pharmacy Partner is Total Life Care Pharmacy out of New Orleans, Louisiana, which has extensive knowledge and experience in providing excellent customer service in the specialty pharmacy environment. Southern Scripts has the highest level of confidence that TLC Rx will provide exceptional care and value to a member's specialty pharmacy needs. There is no financial relationship between Southern Scripts and Total Life Care Pharmacy. Our Customer Service Help Desk will assist members with contact information and steps for having medications filled through TLC Rx.
Supplies are included in the discounted price/dispensing fee for all specialty pharmacy products. Supplies are defined as any item that is necessary for the administration of the drug. Such items may include needles, syringes, and alcohol swabs.
In general, any claim equal or greater to $750 will require a Prior Authorization. Once a patient has completed the Prior Authorization on an initial fill, additional refills will not require Prior Authorization for a designated time period of up to 12 months. Southern Scripts does not charge an additional fee for Prior Authorizations.
Mandatory Generic Policy: If a brand drug is elected when a generic is available, the member will be required to pay the brand copay PLUS the cost difference between the generic drug and the brand drug UNLESS the physician specifies name brand only on the prescription.