Retail pharmacy program Sample Clauses

The Retail Pharmacy Program clause defines the terms and conditions under which covered individuals can obtain prescription medications from participating retail pharmacies. Typically, this clause outlines the network of approved pharmacies, the process for filling prescriptions, and any applicable copayments or limitations on medication quantities. Its core function is to ensure that plan members have convenient access to necessary medications while managing costs and maintaining quality control for the sponsoring organization.
Retail pharmacy program. There will be a retail pharmacy program with easy access to pharmacies throughout the state. Co-pays for a thirty (30) day supply of prescription drugs including coverage of prescriptions from a licensed dentist are: ten dollar ($10.00) co-payment for generic, twenty-five dollar ($25.00) co-pay for a formulary brand name drug and a fifty dollar ($50.00) co-pay for a non- formulary brand name drug. Where a generic equivalent is available, the co-pay for a non-formulary brand name drug shall be fifty dollars ($50.00) and the difference in cost between the generic equivalent and the non- formulary brand name drug. Preventative medication may be provided at no cost as required by the Patient Protection and Affordable Care Act.
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Retail pharmacy program. There will be a retail pharmacy program with easy access to pharmacies throughout the state. Co-pays for a thirty (30) day supply of prescription drugs including coverage of prescriptions from a licensed dentist are: ten dollar ($10.00) co- payment for generic, twenty-five dollar ($25.00) co-pay for a formulary brand name drug and a fifty dollar ($50.00) co-pay for a non-formulary brand name drug. Where a generic equivalent is available, the co-pay for a non-formulary brand name drug shall be fifty dollars ($50.00) and the difference in cost between the generic equivalent and the non-formulary brand name drug. Effective July 1, 2018, co-pays for a thirty-day supply of prescription drugs including coverage of prescriptions from a licensed dentist are: ten dollar ($10.00) co-payment for generic, thirty dollar ($30.00) co-pay for a formulary brand name drug and a fifty-five dollar ($55.00) co- pay for a non-formulary brand name drug. Where a generic equivalent is available, the co-pay for a non-formulary brand name drug shall be fifty-five dollars ($55.00) and the difference in cost between the generic equivalent and the non-formulary brand name drug. Effective July 1, 2019, co-pays for a thirty day supply of prescription drugs including coverage of prescriptions from a licensed dentist are: ten dollar ($10.00) co-payment for generic; thirty five dollar ($35.00) co-pay for a formulary brand name drug and a sixty dollar ($60.00) co-pay for a non-formulary brand name drug. Where a generic equivalent is available, the co-pay for a non- formulary brand name drug shall be sixty dollars ($60.00) and the difference in cost between the generic equivalent and the non- formulary brand name drug. Effective July 1, 2020, co-pays for a thirty-day supply of prescription drugs including coverage of prescriptions from a licensed dentist are: ten dollar ($10.00) co- payment for generic, forty dollar ($40.00) co-pay for a formulary brand name drug and a seventy five ($75.00) co-pay for a non- formulary brand name drug. Where a generic equivalent is available, the co-pay for a non-formulary brand name drug shall be seventy- five dollars ($75.00) and the difference in cost between the generic equivalent and the non-formulary brand name drug. Generic medication classifications will be determined by the PBM based on industry standards in which the PBM utilizes an independent third party data service for new and existing drug product pricing, coding, and classification information....
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Retail pharmacy program. The specific features of the Retail Pharmacy Program are as follows:
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Retail pharmacy program. There will be a retail pharmacy program with easy access to pharmacies throughout the state. Co-pays for a thirty (30) day supply of prescription drugs including coverage of prescriptions from a licensed dentist are: ten dollar ($10.00) co- payment for generic, twenty-five dollar ($25.00) co-pay for a formulary brand name drug and a fifty dollar ($50.00) co-pay for a non-formulary brand name drug. Where a generic equivalent is available, the co-pay for a non-formulary brand name drug shall be fifty dollars ($50.00) and the difference in cost between the generic equivalent and the non-formulary brand name drug. Generic medication classifications will be determined by the PBM based on industry standards in which the PBM utilizes an independent third party data service for new and existing drug product pricing, coding, and classification information. Preventive medication may be provided at no cost as required by the Patient Protection and Affordable Care Act. Specialty medications are filled and mailed by a specialty pharmacy and limited to a thirty (30) day supply; the copays shall be the same as a thirty (30) day supply at retail. For a ninety (90) day supply obtained at a retail pharmacy, the copays shall be three (3) times the copay amounts for a thirty (30) day supply. Oral oncology medications have a maximum copay of one hundred dollars ($100) for a thirty (30) day supply.
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Retail pharmacy program. There will be a retail pharmacy program with easy access to pharmacies throughout the state. Copays for a thirty (30) day supply of prescription drugs including coverage of prescriptions from a licensed dentist are: ten dollar ($10.00) copayment for generic, forty dollar ($40.00) copay for a formulary brand name drug and a seventy five ($75.00) copay for a non-formulary brand name drug. Where a generic equivalent is available, the copay for a non-formulary brand name drug shall be seventy-five dollars ($75.00) and the difference in cost between the generic equivalent and the non-formulary brand name drug. Generic medication classifications will be determined by the PBM based on industry standards in which the PBM utilizes an independent third-party data service for new and existing drug product pricing, coding, and classification information. Preventive medication may be provided at no cost as required by the Patient Protection and Affordable Care Act. Specialty medications are filled and mailed by a specialty pharmacy and limited to a thirty
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