Day Supply. In order to be eligible for coverage under this Certificate, the prescribed day supply must be medically necessary and must not exceed the maximum day supply limitation described in this Certificate. The Plan has the right to determine the day supply. Payment for benefits covered under this benefit section may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumventing, the stated maximum day supply limitation. Specialty Drugs are limited to a 30-day supply. However, some Specialty Drugs have FDA Approved dosing regimens exceeding the 30-day supply limited and may be allowed greater than a 30 day-supply, if allowed by your plan benefits. For information on these drugs call the customer service toll‐free number located on your identification card. However, early prescription refills of topical eye medication used to treat a chronic condition of the eye will be eligible for coverage after at least 75% of the predicted days of use and the early refills requested do not exceed the total number of refills prescribed by the prescribing Physician or Optometrist. Benefits for prescription inhalants will not be restricted on the number of days before an inhaler refill may be obtained. However, you may receive coverage for up to a 12-month supply for dispensed contraceptive drugs and products that are covered under this benefit section. For additional information about early refills, please see the Prescription Refills provision below.
Appears in 4 contracts
Sources: Health Care Benefits Agreement, Health Care Benefits Agreement, Health Care Benefits Agreement
Day Supply. In order to be eligible for coverage under this CertificateBenefit Section, the prescribed day supply must be medically necessary Medically Necessary and must not exceed the maximum day supply limitation described in this CertificateBenefit Section. The Plan has the right to determine the day supply. Payment for benefits covered Benefits under this benefit section Benefit Section may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumventing, the stated maximum day supply limitation. Specialty Drugs Coverage for specialty drugs are limited to a 30-day supply. However, some Specialty Drugs specialty drugs have FDA Approved approved dosing regimens exceeding the 30-day supply limited limits and may be allowed greater than a 30 day-supply, if allowed by your plan benefits. For information on about benefits for these drugs call the customer service toll‐free toll-free telephone number located on your identification cardIdentification Card. However, early Early prescription refills of topical eye medication used to treat a chronic condition of the eye will be eligible for coverage after at least 75% of the predicted days of use use, and the early refills requested do not exceed the total number of refills prescribed by the prescribing Physician or Optometrist. Benefits for prescription inhalants will not be restricted on the number of days before an inhaler refill may be obtained. However, you You may receive coverage for up to a 12-month supply for dispensed contraceptive drugs and products that are covered under this benefit sectionBenefit Section. For additional information about early refills, please see the Prescription Refills provision belowprovision.
Appears in 3 contracts
Sources: Preferred Provider Contract, Preferred Provider Contract, Preferred Provider Contract