Common use of Advanced Control Specialty Formulary Clause in Contracts

Advanced Control Specialty Formulary. a program designed to promote cost effective care for members utilizing specialty medications by encouraging utilization of clinically appropriate and lowest next cost medications. Any member taking a specialty medication that is not included on the advanced control specialty formulary list at the time this program is implemented shall be grandfathered, meaning that he/she shall be allowed to continue taking the non-formulary specialty medication at the member’s cost identified in the prescription plan negotiated by the Union and the Employer for as long as his/her treating physician prescribes such medication. In instances where a member is either taking a specialty medication that is later removed from the advanced control specialty formulary list or a generic equivalent and/or bio- similar alternative is introduced, the member shall be grandfathered if, after consultation between the treating physician and PBM, the treating physician does not agree that the generic equivalent and/or bio-similar alternative is in the best interest of the patient. The County shall provide written and electronic notification to the Union and electronic notification to all Bargaining Unit Members of any medications that are to be added to or 16 The petitioning process will include the Member contacting a Union Designee to provide information and authorization to allow the Union Designee to communicate with the County Benefit Office Designee along with the affected Member. removed from the advanced control specialty formulary list at least 30 calendar days prior to the effective date of the change(s). In addition, the PBM shall also provide written notice to an affected member whenever any medication(s) he/she is taking will be removed from the advanced control specialty formulary list at least 30 calendar days prior to the effective date of the change(s). Notification to the affected member shall include a list of alternative medications that the member may take to the treating physician to discuss treatment options.

Advanced Control Specialty Formulary. a program designed to promote cost effective care for members utilizing specialty medications by encouraging utilization of clinically appropriate and lowest next cost medications. Any member taking a specialty medication that is not included on the advanced control specialty formulary list at the time this program is implemented shall be grandfathered, meaning that he/she shall be allowed to continue taking the non-non- formulary specialty medication at the member’s cost identified in the prescription plan negotiated by the Union and the Employer for as long as his/her treating physician prescribes such medication. In instances where a member is either taking a specialty medication that is later removed from the advanced control specialty formulary list or a generic equivalent and/or bio- bio-similar alternative is introduced, the member shall be grandfathered if, after consultation between the treating physician and PBM, the treating physician does not agree that the generic equivalent and/or bio-similar alternative is in the best interest of the patient. The County shall provide written and electronic notification to the Union and electronic notification to all Bargaining Unit Members of any medications that are to be added to or 16 12 The petitioning process will include the Member contacting a Union Designee to provide information and authorization to allow the Union Designee to communicate with the County Benefit Office Designee along with the affected Member. electronic notification to all Bargaining Unit Members of any medications that are to be added to or removed from the advanced control specialty formulary list at least 30 calendar days prior to the effective date of the change(s). In addition, the PBM shall also provide written notice to an affected member whenever any medication(s) he/she is taking will be removed from the advanced control specialty formulary list at least 30 calendar days prior to the effective date of the change(s). Notification to the affected member shall include a list of alternative medications that the member may take to the treating physician to discuss treatment options.

Advanced Control Specialty Formulary. a program designed to promote cost effective care for members utilizing specialty medications by encouraging utilization of clinically appropriate and lowest next cost medications. Any member taking a specialty medication that is not included on the advanced control specialty formulary list at the time this program is implemented shall be grandfathered, meaning that he/she shall be allowed to continue taking the non-formulary specialty medication at the member’s cost identified in the prescription plan negotiated by the Union and the Employer for as long as his/her treating physician prescribes such medication. In instances where a member is either taking a specialty medication that is later removed from the advanced control specialty formulary list or a generic equivalent and/or bio- similar alternative is introduced, the member shall be grandfathered if, after consultation between the treating physician and PBM, the treating physician does not agree that the generic equivalent and/or bio-similar alternative is in the best interest of the patient. The County shall provide written and electronic notification to the Union and electronic notification to all Bargaining Unit Members of any medications that are to be added to or 16 The petitioning process will include the Member contacting a Union Designee to provide information and authorization to allow the Union Designee to communicate with the County Benefit Office Designee along with the affected Member. removed from the advanced control specialty formulary list at least 30 calendar days prior to the effective date of the change(s). In addition, the PBM shall also provide written notice to an affected member whenever any medication(s) he/she is taking will be removed from the advanced control specialty formulary list at least 30 calendar days prior to the effective date of the change(s). Notification to the affected member shall include a list of alternative medications that the member may take to the treating physician to discuss treatment options.