Prescription Drug Benefits. A-9.01 All eligible employees shall be entitled to prescription drug benefits for themselves and their eligible dependants. Prescription drug benefits shall cover one hundred (100%) percent of the cost of prescription drugs up to the employee’s Pharmacare deductible based on those drugs covered by Pharmacare. (Any employees currently on drugs not covered by Pharmacare shall be allowed to continue as long as medically required.)
Prescription Drug Benefits. Benefits are available for outpatient prescription Drugs. Outpatient prescription Drugs are self-administered Drugs approved by the U.S. Food and Drug Administration (FDA) for sale to the public through retail or mail-order pharmacies that are prescribed and are not provided for use on an inpatient basis. Drugs also include diabetic testing supplies. A Physician or Health Care Provider must prescribe all Drugs covered under this Benefit, including over-the-counter items. You must obtain all Drugs from a Participating Pharmacy, except as noted below. Drugs, items, and services that are not covered under this Benefit are listed in the Exclusions and limitations section. Some Drugs, most Specialty Drugs, and prescriptions for Drugs exceeding specific quantity limits require prior authorization to be covered. The prior authorization process is described in the Prior authorization/exception request/step therapy process section. You or your Physician may request prior authorization from Blue Shield. Outpatient Drug Formulary Blue Shield’s Drug Formulary is a list of FDA-approved preferred Generic and Brand Drugs. This list helps Physicians or Health Care Providers prescribe Medically Necessary and cost-effective Drugs. Blue Shield’s Formulary is established and maintained by Blue Shield’s Pharmacy and Therapeutics (P&T) Committee. This committee consists of Physicians and pharmacists responsible for evaluating Drugs for relative safety, effectiveness, evidence-based health benefit, and comparative cost. The committee also reviews new Drugs, dosage forms, usage, and clinical data to update the Formulary four times a year. Your Physician or Health Care Provider might prescribe a Drug even though it is not included in the Blue Shield Formulary. The Formulary is divided into Drug tiers. The tiers are described in the chart below. Your Copayment or Coinsurance will vary based on the Drug tier. Drugs are placed into tiers based on recommendations made by the P&T Committee. Formulary Drug tiers Drug Tier Description Tier 1 • Most Generic Drugs or low-cost preferred Brand Drugs Tier 2 • Non-preferred Generic Drugs • Preferred Brand Drugs • Any other Drugs recommended by the P&T Committee based on drug safety, efficacy, and cost Tier 3 • Non-preferred Brand Drugs • Drugs recommended by the P&T Committee based on drug safety, efficacy, and cost • Drugs that generally have a preferred and often less costly therapeutic alternative at a lower tier Tier 4 • Drugs that are bio...
Prescription Drug Benefits. 1. Employees who enroll in the HDHP-HSA shall enroll in the Express Scripts (ESI) Public Sector Three-Tier Prescription Drug Plan. Prescription drug costs at the ESI negotiated rates will apply towards the annual HDHP deductible. Upon reaching the HDHP deductible, prescriptions co-payments of $5 for generic drugs, $30 for listed brand name drugs, and $45 for non- listed brand name drugs, and required generic substitution, for a 30-day supply shall become the effective prescription costs. Mail order co- payments for a 90-day supply of maintenance medications are twice the co- pay for a 30-day supply. For non-participating pharmacies, the plan pays 70% of the Express Scripts (ESI) allowance.
Prescription Drug Benefits. The Summary of Pharmacy Benefits only applies to prescription drugs purchased at a retail, mail order, or specialty, pharmacy. For information about our pharmacy network, visit our website or call our Customer Service Department.
Prescription Drug Benefits. 1. Employees who enroll in the Century Preferred Managed Care Program or the Blue Care POS Plan shall enroll in the Anthem Public Sector Three-Tier Prescription Drug Plan with co-payments of $10 for generic drugs, $20 for listed brand name drugs, and $30 for non-listed brand name drugs, and required generic substitution, for a 30-day supply. Mail order co-payments for a 90-day supply of maintenance medications are twice the co-pay for a 30-day supply. For non-participating pharmacies, the plan pays 70% of the Anthem allowance. The annual maximum benefit is $1,000.00.
Prescription Drug Benefits. Please refer to the Schedule of Benefits for Cost-Sharing requirements, supply limits, and any Preauthorization or Referral requirements that apply to these benefits.
Prescription Drug Benefits. A. Coverage is available for Prescription Drugs if shown as covered in the Schedule of Benefits. The Prescription Drugs must be dispensed on or after the Member’s Effective Date by a licensed pharmacist or a pharmacy technician under the direction of a licensed pharmacist, upon the prescription of a Physician or an Allied Health Professional who is licensed to prescribe drugs. Benefits are based on the Allowable Charge that We determine and only those Prescription Drugs that We determine are Medically Necess ary will be covered. Certain Prescription Drugs may be subject to Step Therapy or require prior Authorization as shown in the Schedule of Benefits.
Prescription Drug Benefits. All designated Retail Pharmacies. (Up to a 30-day formulary supply for each prescription or refill). $10 for Tier 1 $20 for Teir 2 $35 for Teir 3 Through the designated Mail Service Pharmacy. (Up to a 90- day supply for each prescription or refill). $10 for Tier 1 $20 for Teir 2 $35 for Teir 3 The School District will maintain the current employee-funded Section 125 plans relating to pre-tax health and dental coverage. The parties agree that there shall be no change in premium contribution (premium split) or plan design (co- payments and out-of-pocket expenses) for the current Network Blue New England plan for the duration of this agreement. When an employee retires, the employee may elect to remain in the Group Health Insurance Plan if the employee contributed to and is receiving a pension from the City of Xxxxxxxx Retirement Board. Pursuant to MGL c. 32B § 18A, a retired employee, spouse, or dependent who is Medicare eligible shall be transferred to the School District’s Medicare health plan upon reaching the age of sixty-five (65).
Prescription Drug Benefits. Retail Program: Copay per prescription $10.00/$15.00/$30.00 30 Day Supply Brand/Generic If you want brand name you pay $5.00 plus the cost difference between generic and brand name. Mail Order Program: Copay per prescription $20.00/$30.00/$60.00 90 Day Supply Brand/Generic * Addition of oral contraceptives Dental Plan: Sealants for Children under age 14 Pre-Molars 100% R&C
Prescription Drug Benefits. The Prescription Drug coverage helps to meet the cost of legend drugs. A legend drug is a compound or substance that requires, under federal law, a written prescription by a licensed doctor of medicine or osteopath, dentist or podiatrist who is legally licensed to prescribe medications. It is a drug or medication that cannot be sold over the counter without a written prescription. Exclusions are as follows: Non-Legend drugs other than insulin. Charges for the administration or injection of any drug. Therapeutic devices or appliances, including support garments and other non-medicinal substances, regardless of intended use; insulin syringes/needles when prescribed alone, any syringes/needles for other than diabetic use. Prescriptions that an eligible person is entitled to receive without charge from any Worker’s Compensation Laws, or any Municipal, State, or Federal Program. Drugs labeled “Caution - limited by Federal law to investigational use”, or experimental drugs, even though a charge is made to the individual. Immunization agents, biological sera, blood or blood plasma. Medication which is to be taken by or administered to an individual, in whole or in part, while he/she is a patient in a licensed hospital, rest home, sanitarium, extended care facility, convalescent hospital, nursing home, or similar institution which operates on its premises, or allows to be operated on its premises, a facility for dispensing pharmaceuticals. Any prescription refilled in excess of the number specified by the physician, or any refill dispensed after one (1) year from the physician’s original order. Contraceptive devices. Norplant.
