Drug Formulary Exclusions List. A list of prescription drugs excluded from the Drug Formulary, subject to change from time to time at the sole discretion of HMO. ● Generic Prescription Drug(s). Prescription drugs and insulin, whether identified by their chemical, proprietary, or non-proprietary name, that are accepted by the U.S. Food and Drug Administration as therapeutically equivalent and interchangeable with drugs having an identical amount of the same active ingredient and so indicated by MediSpan or any other similar publication designated by HMO or an affiliate. • Non-Formulary Prescription Drug(s). A product or drug not listed on the Drug Formulary which includes drugs listed on the Drug Formulary Exclusions List. • Participating Mail Order Pharmacy. A pharmacy, which has contracted with HMO or an affiliate to provide covered outpatient prescription drugs or medicines, and insulin to Members by mail or other carrier.
Drug Formulary Exclusions List. A list of prescription drugs excluded from the Drug Formulary, subject to change from time to time. The prescription drugs on the Drug Formulary Exclusions List are not excluded from coverage. Prescription drugs on the Drug Formulary Exclusions List will be covered at the highest Copayment. • Generic Prescription Drug(s). Prescription drugs and insulin, whether identified by its chemical, proprietary, or non-proprietary name, that is accepted by the U.S. Food and Drug Administration as therapeutically equivalent and interchangeable with drugs having an identical amount of the same active ingredient and so indicated by MediSpan or any other similar publication designated by HMO. • Non-Formulary Prescription Drug(s). A product or drug not listed on the Drug Formulary which includes drugs listed on the Drug Formulary Exclusions List. Non-Formulary Prescription Drugs are covered under this rider without Prior Authorization at the highest Copayment.
Drug Formulary Exclusions List. A list of prescription drugs excluded from the Drug Formulary, subject to change from time to time at the sole discretion of HMO. Generic Prescription Drug(s). Prescription drugs and insulin, whether identified by their chemical, proprietary, or non-proprietary name, that are accepted by the U.S. Food and Drug Administration as therapeutically equivalent and interchangeable with drugs having an identical amount of the same active ingredient and so indicated by MediSpan or any other similar publication designated by HMO or an affiliate. • Low-Protein Modified Food Products. A product formulated to have less than 1 gram of protein per serving and intended for the dietary treatment of an inherited metabolic disease. • Non-Formulary Prescription Drug(s). A product or drug not listed on the Drug Formulary which includes drugs listed on the Drug Formulary Exclusions List. • Participating Mail Order Pharmacy. A pharmacy, which has contracted with HMO or an affiliate to provide covered outpatient prescription drugs or medicines, and insulin to Members by mail or other carrier.
Drug Formulary Exclusions List. A list of prescription drugs excluded from the Drug Formulary, subject to change from time to time at the sole discretion of HMO. • Generic Prescription Drug(s). Prescription drugs and insulin, whether identified by its chemical, proprietary, or non-proprietary name, that is accepted by the U.S. Food and Drug Administration as therapeutically equivalent and interchangeable with drugs having an identical amount of the same active ingredient and so indicated by MediSpan or any other similar publication designated by HMO or an affiliate. • Maintenance Drug(s). A listing of prescription drugs or medications established by HMO or an affiliate which is subject to periodic review and modification by HMO or an affiliate. The list consists of prescription drugs or medications that are taken for extended periods of time, and which do not vary frequently in terms of dosage (such as high blood pressure medication). • Non-Formulary Prescription Drug(s). A product or drug not listed on the Drug Formulary which includes drugs listed on the Drug Formulary Exclusions List. • Participating Mail Order Pharmacy. A pharmacy, which has contracted with HMO or an affiliate to provide covered outpatient prescription drugs or medicines, and insulin to Members by mail or other carrier.
