Restricted Pharmacy Sample Clauses

Restricted Pharmacy. We may limit your selection of a pharmacy to one (1) pharmacy. Those members subject to this restriction include, but are not limited to, members that have a history of:  being prescribed prescription drugs by multiple physicians;  having prescriptions drugs filled at multiple pharmacies;  being prescribed certain long acting opioids and other controlled substances, either in combination or separately, that suggests a need for monitoring due to: o quantities dispensed; o daily dosage range; or o the duration of therapy exceeds reasonable and established thresholds. Covered Over-the-Counter (OTC) Drugs In accordance with PPACA, certain preventive over-the-counter (OTC) drugs when prescribed by a physician are covered. To obtain a specific list of the OTC drugs that are covered, call our Customer Service Department or visit our Web site at xxx.XXXXXX.xxx.
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Restricted Pharmacy. We may limit your selection of a pharmacy to one (1) network pharmacy. Members subject to this restriction are those members that have been prescribed prescriptions by multiple physicians and have had prescriptions filled at multiple pharmacies. Contact our Customer Service Department for more information. How Covered Prescription Drugs and Diabetic Supplies/Equipment Are Paid When you buy covered prescription drugs and diabetic equipment and supplies from a network pharmacy, you will be responsible for the copayment and prescription drug deductible (if any) shown in the Summary of Pharmacy Benefits at the time you buy the prescription drugs and diabetic equipment and supplies. Coverage is based on our pharmacy allowance. This agreement does NOT cover generic, preferred brand name, and non-preferred brand name prescription drugs or diabetic equipment and supplies when bought at non-network pharmacies. If you buy generic, preferred brand name, and non-preferred brand name prescription drugs or diabetic equipment and supplies from non-network pharmacies, you will be responsible to pay the charge for the prescription drug or diabetic equipment and supplies at the time the prescription is filled. If you buy specialty prescription drugs from a retail network pharmacy or a non-network pharmacy, you will be responsible to pay the charge for the specialty prescription drug at the time the prescription is filled. You may submit a claim to us and we will reimburse you directly. You will be responsible for the copayment shown in the Summary of Pharmacy Benefits and the difference between the charge and the pharmacy allowance. See Section 7.1 - How to File a Claim. How to Obtain Prescription Drug Preauthorization Prescription drug preauthorization is required for certain brand name prescription drugs and certain specialty prescription drugs. To obtain prescription drug preauthorization, the prescribing provider must submit a completed prescription drug preauthorization request form. The prescribing provider may obtain a prescription drug preauthorization form by visiting our Web site at XXXXXX.xxx or calling the Physician and Provider Service Center. Preauthorization requests may be submitted in one of the following ways: • By fax, submit the form to CVS Caremark at 0-000-000-0000; • By phone, contact CVS Caremark at 0-000-000-0000; • By mail, send the completed form to: CVS Caremark Prior Authorization Center 0000 X. Xxxxxxxx Road Richardson, TX 75081 Prescription dr...
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