Outpatient Prescription Drug Benefits Sample Clauses

Outpatient Prescription Drug Benefits. Prescription Drugs obtained from a Participating Pharmacy. You may call the 800 number on your identification card for assistance in a Participating Pharmacy. The Formulary is subject to change. Drugs may be deleted from the Formulary during the year if significant safety issues arise, or if new products come to the market that are superior in efficiency and or safety. If a New Drug is determined as safe and effective as currently available therapies, the cost effectiveness of the drug is reviewed. Typically, if the cost is comparable or better than existing therapies, the drug is added to the Formulary. Drugs listed on the Formulary will be included in Covered Drugs if they not excluded, the appropriate Copay and/or Deductible and Coinsurance is paid, and any required Prior Authorization is received. Some Prescription Drugs are subject to Step Therapy. Step Therapy is an automated process that defines how and when a particular drug can be dispensed based on your drug history. Step therapy usually requires the use of one or more prerequisite drugs prior to the use of another drug. You may obtain a copy of the current Formulary at no charge by contacting us at: Address: US Health and Life Insurance Company Attention: Customer Service [000 Xxxxx Xxxxx, Xxxxx 000 Troy, MI 48098] Telephone: [000-000-0000] Website: [xxx.xxxxxxxxxxxxxxxxxxxxxxxxx.xxx] Covered Prescription Drugs The Company covers only drugs that are:
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Outpatient Prescription Drug Benefits. This benefit includes access to Blue Shield’s Participating Pharmacy Network. By presenting your Blue Shield Identifi- cation Card to a Participating Pharmacy you will pay Blue Shield’s contracted rate for covered medication. This will significantly reduce your out of pocket costs for covered medications. Please see the section entitled “Obtaining Out- patient Prescription Drugs at a Participating Pharmacy” for more details. The following prescription drug benefit is separate from the Shield Spectrum PPO Plan coverage. The Calendar Year Maximum Copayment and Medical Plan Deductible provisions do not apply to the outpatient prescrip- tion drug benefit; however, the general provisions and exclu- sions of the Shield Spectrum PPO Plan contract shall apply. Benefits for covered Brand Name Drugs are subject to a per Member, per Calendar Year Brand Name Drug Deductible as shown in the Summary of Benefits. Note: Except for covered emergencies, no benefits are pro- vided for drugs received from Non-Participating Pharmacies.
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Outpatient Prescription Drug Benefits. Prescription Drugs obtained from a Participating Pharmacy. You may call the 800 number on your identification card for assistance in a Participating Pharmacy. The Formulary is subject to change. Drugs may be deleted from the Formulary during the year if significant safety issues arise, or if new products come to the market that are superior in efficiency and or safety. If a new drug is determined as safe and effective as currently available therapies, the cost effectiveness of the drug is reviewed. Typically, if the cost is comparable or better than existing therapies, the drug is added to the Formulary. Drugs listed on the Formulary will be included in Covered Drugs if they not excluded, the appropriate Copay and/or Deductible and Coinsurance is paid, and any required Prior Authorization is received. Some Prescription Drugs are subject to Step Therapy. Step Therapy is an automated process that defines how and when a particular drug can be dispensed based on your drug history. Step therapy usually requires the use of one or more prerequisite drugs prior to the use of another drug. You may request access to clinically appropriate drugs not covered or obtain a copy of the current Formulary at no charge by contacting us at: Address: US Health and Life Insurance Company Attention: Customer Service [0000 Xxxxxx Xxxx Sterling Heights, MI 48312] Telephone: [000-000-0000] Fax: [000-000-0000] Website: [xxx.xxxxxxxxxxxxxxxxxxxxxxxxx.xxx] Covered Prescription Drugs The Company covers only drugs that are:
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Outpatient Prescription Drug Benefits. The following prescription drug Benefit is separate from the Health Plan coverage. The Calendar Year maximum Co- payments and the Coordination of Benefits provision do not apply to this Outpatient Prescription Drug Benefits Supple- ment; however, the general provisions and exclusions of the Health Plan contract shall apply. Benefits are provided for Outpatient prescription Drugs which meet all of the requirements specified in this supple- ment, are prescribed by the Member’s Personal Physician, are obtained from a Participating Pharmacy, and are listed in the Drug Formulary. Drug coverage is based on the use of Blue Shield’s Outpatient Drug Formulary, which is updated on an ongoing basis by Blue Shield’s Pharmacy and Therapeutics Committee. A Non-Formulary Drug may be covered but only through the prior authorization process described herein. Select Drugs and Drug dosages and most Specialty Drugs require prior authorization by Blue Shield for Medical Neces- sity, appropriateness of therapy or when effective, lower cost alternatives are available. Your Physician may request prior authorization from Blue Shield. Coverage for selected Drugs may be limited to a specific quantity as described in “Limitation on Quantity of Drugs that may be Obtained per Prescription or Refill”. Outpatient Drug Formulary Medications are selected for inclusion in Blue Shield’s Out- patient Drug Formulary based on safety, efficacy, FDA bioequivalency data and then cost. New drugs and clinical data are reviewed regularly to update the Formulary. Drugs considered for inclusion or exclusion from the Formulary are reviewed by Blue Shield’s Pharmacy and Therapeutics Committee during scheduled meetings four times a year. A Non-Formulary Drug may be covered only if prior author- ized by Blue Shield. Your Physician may request prior au- thorization. For instructions regarding obtaining prior author- ization, see the section entitled Prior Authorization Process for Non-Formulary Drugs later in this supplement. Members may call Blue Shield Member Services at the num- ber listed on their Blue Shield Identification Card to inquire if a specific drug is included in the Formulary. Member Ser- vices can also provide Members with a printed copy of the Formulary. Members may also access the Formulary through the Blue Shield of California web site at xxxx://xxx.xxxxxxxxxxxx.xxx. Definitions Brand Name Drugs — Drugs which are FDA approved ei- ther (1) after a new drug application, or (2) after an abbr...
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Outpatient Prescription Drug Benefits. Prescription Drugs obtained from a Participating Pharmacy. You may call the 800 number on your identification card for assistance in a Participating Pharmacy. The Formulary is subject to change. Modifications will occur at the time of the plan renewal and coverage for the drug being removed will continue to be covered until the renewal date of the plan. Drugs may be deleted from the Formulary during the year if significant safety issues arise, or if new products come to the market that are superior in efficiency and or safety. If a new drug is determined as safe and effective as currently available therapies, the cost effectiveness of the drug is reviewed. Typically, if the cost is comparable or better than existing therapies, the drug is added to the Formulary. Drugs listed on the Formulary will be included in Covered Drugs if they are not excluded, the appropriate Copay and/or Deductible and Coinsurance is paid, and any required Prior Authorization is received. Some Prescription Drugs are subject to Step Therapy. Step Therapy is an automated process that defines how and when a particular drug can be dispensed based on your drug history. Step therapy usually requires the use of one or more prerequisite drugs prior to the use of another drug. The Step Therapy process does not apply to coverage for stage-four advanced, metastatic cancer and associated conditions. No proof of history of failure or failure to respond to a different drug will be required. This applies when the drug prescribed is consistent with best practices for the treatment of stage-four advanced, metastatic cancer or an associated condition; supported by peer-reviewed, evidence-based literature; and approved by the USFDA. You may obtain a copy of the current Formulary at no charge by contacting us at: Address: US Health and Life Insurance Company Attention: Customer Service [000 Xxxxx Xxxxx, Xxxxx 000 Troy, MI 48098] Telephone: [000-000-0000] Website: [xxx.xxxxxxxxxxxxxxxxxxxxxxxxx.xxx] Covered Prescription Drugs The Company covers only drugs that are:
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Related to Outpatient Prescription Drug Benefits

  • Prescription Drug Plan Effective January 1, 2022, retail and mail order prescription drug copays for bargaining unit employees shall be as follows: Type of Drug Prescriptions for 1-45 Days (1 copay) Prescriptions for 46-90 Days (2 copays) Generic drug $10 $20 Preferred brand name drug $25 $50 Non- referred brand name drug $40 $80 Effective January 1, 2022, for each plan year the Prescription Drug annual out-of-pocket copay maximum shall be $1,000 for individual coverage and $1,500 for employee and spouse, employee and child, or employee and family coverage.

  • Prescription Drugs The agreement may impose a variety of limits affecting the scope or duration of benefits that are not expressed numerically. An example of these types of treatments limit is preauthorization. Preauthorization is applied to behavioral health services in the same way as medical benefits. The only exception is except where clinically appropriate standards of care may permit a difference. Mental disorders are covered under Section A. Mental Health Services. Substance use disorders are covered under Section

  • Outpatient If you receive dialysis services in a hospital's outpatient unit or in a dialysis facility, we cover the use of the treatment room, related supplies, solutions, drugs, and the use of the dialysis machine. In Your Home If you receive dialysis services in your home and the services are under the supervision of a hospital or outpatient facility dialysis program, we cover the purchase or rental (whichever is less, but never to exceed our allowance for purchase) of the dialysis machine, related supplies, solutions, drugs, and necessary installation costs. Related Exclusions If you receive dialysis services in your home, this agreement does NOT cover: • installing or modifying of electric power, water and sanitary disposal or charges for these services; • moving expenses for relocating the machine; • installation expenses not necessary to operate the machine; or • training you or members of your family in the operation of the machine. This agreement does NOT cover dialysis services when received in a doctor’s office.

  • Prescription Safety Glasses Prescription safety glasses will be furnished by the employer. The employer retains the authority to establish reasonable rules and procedures regarding frequency of issue, replacement of damaged glasses, limits on reimbursement costs and coordination with the employer's vision plan.

  • Alcohol and Drug Testing Employee agrees to comply with and submit to any Company program or policy for testing for alcohol abuse or use of drugs and, in the absence of such a program or policy, to submit to such testing as may be required by Company and administered in accordance with applicable law and regulations.

  • Health Promotion and Health Education Both parties to this Agreement recognize the value and importance of health promotion and health education programs. Such programs can assist employees and their dependents to maintain and enhance their health, and to make appropriate use of the health care system. To work toward these goals:

  • Extended Health Care Benefits 12.02(a) The City will provide for all employees by contract through an insurer selected by the City an Extended Health Care Plan which will provide extended health care benefits. The City shall pay one hundred per cent (100%) of the premiums, which will include any premiums payable under The Health Insurance Act, R.S.O. 1990, as amended. Eligible Expenses (Benefit year January 1 – December 31)

  • Prescription Claims against the Issuer or any Guarantor for the payment of principal or Additional Amounts, if any, on the Notes will be prescribed ten years after the applicable due date for payment thereof. Claims against the Issuer or any Guarantor for the payment of interest on the Notes will be prescribed five years after the applicable due date for payment of interest.

  • Dependent Care Assistance Program The County offers the option of enrolling in a Dependent Care Assistance Program (DCAP) designed to qualify for tax savings under Section 129 of the Internal Revenue Code, but such savings are not guaranteed. The program allows employees to set aside up to five thousand dollars ($5,000) of annual salary (before taxes) per calendar year to pay for eligible dependent care (child and elder care) expenses. Any unused balance is forfeited and cannot be recovered by the employee.

  • Patient Care Resident shall participate in safe, effective, and compassionate patient care, under supervision, commensurate with Resident's level of advancement and responsibility.

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