Common use of Mail Order Pharmacy Clause in Contracts

Mail Order Pharmacy. This is an establishment where prescription drugs are legally dispensed by mail. Health care or dental services, and supplies or prescription drugs that a physician, other health care provider or dental provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating an sickness or injury or its symptoms, and that provision of the service, supply or prescription drug is: • In accordance with generally accepted standards of medical or dental practice; • Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient’s sickness or injury; • Not primarily for the convenience of the patient, physician, or other health care or dental provider; and • Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s sickness or injury. For these purposes “generally accepted standards of medical or dental practice” means standards that are based on credible scientific evidence published in peer-reviewed literature generally recognized by the relevant medical or dental community, or otherwise consistent with physician or dental specialty society recommendations and the views of physicians or dentists practicing in relevant clinical areas and any other relevant factors. These are health care services that Aetna determines that a provider, exercising prudent clinical judgment, would provide to a patient for the purpose of preventing, evaluating, diagnosing or treating sickness, injury, disease or its symptoms, and that Aetna determines are: • In accordance with generally accepted standards of medical practice; • Clinically appropriate, in terms of type, frequency, extent, site and duration, and considered effective for the patient’s sickness, injury or disease; • Not primarily for the convenience of the patient, physician, or other health care provider; and • Not more costly than an alternative service or sequence of services at least as likely to produce equivalent therapeutic or diagnostic results as to the diagnosis or treatment of that patient’s sickness, injury or disease. Generally accepted standards of medical practice means: • Standards that are based on credible scientific evidence published in peer-reviewed medical literature generally recognized by the relevant medical community; and • Consistent with the standards set forth in policy issues involving clinical judgment. This is a listing of prescription drugs which have been evaluated and selected by Aetna clinical pharmacists; for their therapeutic equivalency and efficacy. This listing includes both brand name and generic prescription drugs. This listing is subject to periodic review; and modification by Aetna.