Prescription Drug Plans Clause Samples
Prescription Drug Plans a. MCPS will implement a managed prescription drug plan that combines utilization review, physician profiling, and case-management techniques. The plan will protect a physician’s ability to make a final medical determination of the appropriate medication. The plan’s co-pay- ment structure is designed to encourage participants to purchase prescription drugs at the most affordable price.
b. The prescription drug co-payment schedule will be as follows: Generic Drugs $5 $10 $5 $10 Brand Name, Formulary List Drugs $20 $25 $20 $25 Brand Name, Non-Formulary, no generic equivalent $35 $40 $35 $40 Brand Name, Non-Formulary, generic is available $35 plus the difference $40 plus the difference $35 plus the difference $40 plus the difference
c. Generic Equivalent Rules—Prescriptions for non-formulary brand-name drugs with a generic equivalent will be filled automatically with a generic, and the participant will be charged the lower generic class co-pay. If the physician specifies to dispense as written, or if the participant opts for brand-name non-formulary drugs, such drugs will be dispensed and the co-pay shall include the added difference in cost for the name-brand drug over the generic drug.
d. Formulary Drug List (a.k.
a. “Primary Drug List”) is a list of preferred brand-name medi- cines that have been reviewed and selected by the pharmacy benefit manager’s “Pharmacy and Therapeutics Committee” of practicing doctors and clinical pharmacists for their safety, quality, and effectiveness.
e. Maintenance Drug Class—Maintenance medications are drugs usually prescribed to treat conditions of a long-term or chronic nature, such as diabetes, arthritis, or high blood pres- sure. Drugs are classified according to therapeutic category and those drugs that are consid- ered as maintenance medications under the plan are identified through the pharmacy benefit manager. Two initial 30-day prescriptions for maintenance drugs may be filled at a retail phar- macy. Following that, maintenance drugs must be filled through the mail-order pharmacy program. If such subsequent maintenance drug prescriptions are purchased at a retail phar- macy, the plan shall pay only as much as it would have if the drug had been purchased by mail order—and the participant shall pay the difference. Participants may choose to continue purchasing their maintenance drugs in 30 day prescriptions at a retail pharmacy beyond the first two months. If they do, the co-pay shall be the mail order co-pay for a 30-...
Prescription Drug Plans a. MCPS will implement a managed prescription drug plan which combines utilization review, physician profiling and case management techniques. The plan will protect a physician's ability to make a final medical determination of the appropriate medication. The plan’s co-payment structure is designed to encourage participants to purchase prescription drugs at the most affordable price.
b. The prescription drug co-payment schedule will be: DRUG CLASS Retail 30 day supply Domestic Mail Order 3-month supply Generic Drugs $5 $10 $5 $10 Brand Name, Formulary List Drugs $20 $25 $20 $25 Brand Name, Non- Formulary, no generic equivalent $35 $40 $35 $40 Brand Name, Non- Formulary, generic is available $35 plus the difference $40 plus the difference $35 plus the difference $40 plus the difference
Prescription Drug Plans a . MCPS will implement a managed prescription drug plan which combines utilization review, physician profiling and case management tech- niques . The plan will protect a physician’s ability to make a final medical determination of the appropriate medication . The plan’s co-payment structure is designed to encourage participants to purchase prescription drugs at the most af- fordable price .
b . The prescription drug co-payment schedule will be: 1-3 60 40 4-6 70 30 7-12 80 20 Over 12 Years 85 15 Generic Drugs $5 $0
Prescription Drug Plans a. MCPS will implement a managed prescription drug plan which combines utilization review, physician profiling and case management techniques. The plan will protect a physician's ability to make a final medical determination of the appropriate medication. The plan’s co-payment structure is designed to encourage participants to purchase prescription drugs at the most affordable price.
b. The prescription drug co-payment schedule, through 12/31/12, will be: DRUG CLASS Retail 30 day supply Domestic Mail Order 3-month supply Generic Drugs $5 $0 Brand Name, Formulary List Drugs $10 $10 Brand Name, Non-Formulary, no generic equivalent $25 $25 Brand Name, Non-Formulary, generic is available $25 plus the difference $25 plus the difference The prescription drug co-payment schedule, effective 1/1/13, will be: DRUG CLASS Retail 30 day supply Domestic Mail Order 3-month supply Generic Drugs $5 $5 Brand Name, Formulary List Drugs $20 $20 Brand Name, Non-Formulary, no generic equivalent $35 $35 Brand Name, Non-Formulary, generic is available $35 plus the difference $35 plus the difference
Prescription Drug Plans. The Consortium currently offers both two-tier and three-tier copayment structure prescription drug plans. The overwhelming majority of the covered members are enrolled in the three-tier prescription drug programs which is a formulary based product that charges a different copayment based on the tier classification of the medication being purchased. The following are the current two-tier and three-tier prescription drug options available: