Common use of SPECIALTY PRESCRIPTION Clause in Contracts

SPECIALTY PRESCRIPTION. DRUG is a type of prescription drug in our formulary that generally is identified by, but not limited to, features such as:  being produced by DNA technology,  treats chronic or long term disease,  requires customized clinical monitoring and patient support, and  needs special handling. Generally, specialty pharmacies dispense specialty prescription drugs. Contact Customer Service for further details and information about specialty prescription drugs and specialty pharmacies. For the purposes of this agreement, we have designated certain prescribed prescription drugs to be specialty prescription drugs in our formulary. To obtain coverage information for any specific specialty prescription drug or to obtain a copy of the most current formulary listing, visit our Web site at XXXXXX.xxx. Or, you may call our Customer Service Department at (000) 000-0000 or 0-000-000-0000. Generic, Preferred Brand Name or Non-Preferred Brand Name Prescription Drugs Generic, preferred brand name, or non-preferred brand name prescription drugs we have approved that are dispensed and administered by a licensed health care provider (other than a pharmacy) are covered under this agreement, subject to the copayment and deductible (if any) shown in the Summary of Medical Benefits. The generic, preferred brand name, or non- preferred brand name prescription drug must be dispensed per our dispensing guidelines in order to be covered. Inpatient We cover inpatient drugs as a hospital service. See Section 8.0 - definition of hospital services. Outpatient/In Your Doctor’s Office/In Your Home Generic, preferred brand name, or non-preferred brand name prescription drugs are covered at different benefit levels depending upon the route of administration. Our allowance for services rendered by the facilities, agencies, and professional providers may include the cost of the prescription drugs administered and/or dispensed. We will determine coverage based upon the route of administration that is customary and least invasive method to treat the condition. There are several ways to administer drugs into the body including:  inhalation (into the lungs, usually through the mouth);  intramuscular (injected into a muscle);  intra-articular (injected into a skeletal joint space);  intrathecal (injected into the space around the spinal cord);  intravenous/infused/intra-arterial (into a vein or artery);  nasal (sprayed into the nose);  ocular (instilled in the eye);  oral (by mouth);  rectal or vaginal (inserted into the rectum or vagina);  subcutaneous (injected beneath the skin);  sublingual (under the tongue);  topical (applied to the skin); OR  transdermal (delivered through the skin by a patch). Inhalation, Nasal, Ocular, Oral, Rectal Or Vaginal, Sublingual, Topical, And Transdermal Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs The prescription drug is included in our allowance for the medical service being rendered. If the sole service is drug dispensing, the prescription drug is NOT covered. Injected Generic, Preferred Brand Name or Non-Preferred Brand Name Prescription Drugs We use the term injected to include prescription drugs approved by us given by intra muscular or subcutaneous injection or in the case of a body cavity by instillation. See the Summary of Medical Benefits for benefit limits and the amount that you pay. See Section 3.29 Prevention and Early Detection Services for immunization and vaccination coverage information. Infused Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs We use the term infused to include those prescription drugs approved by us and administered into a vein or into an artery whether by mixing in fluids and administering intravenously or into an artery, direct injection, or by use of a pump that accesses the vein or artery. See the Summary of Medical Benefits for benefit limits and the amount that you pay.

SPECIALTY PRESCRIPTION. DRUG is a type of prescription drug in our formulary that generally is identified by, but not limited to, features such as:  being produced by DNA technology,  treats chronic or long term disease,  requires customized clinical monitoring and patient support, and  needs special handling. Generally, specialty pharmacies dispense specialty prescription drugs. Contact Customer Service for further details and information about specialty prescription drugs and specialty pharmacies. For the purposes of this agreement, we have designated certain prescribed prescription drugs to be specialty prescription drugs in our formulary. To obtain coverage information for any specific specialty prescription drug or to obtain a copy of the most current formulary listing, visit our Web site at XXXXXX.xxx. Or, you may call our Customer Service Department at (000) 000-0000 or 0-000-000-0000. Generic, Preferred Brand Name Name, or Non-Preferred Brand Name Prescription Drugs Generic, preferred brand name, or non-preferred brand name prescription drugs we have approved that are dispensed and administered by a licensed health care provider (other than a pharmacy) are covered under this agreement, subject to the copayment and deductible (if any) shown in the Summary of Medical Benefits. The generic, preferred brand name, or non- preferred brand name prescription drug must be dispensed per our dispensing guidelines in order to be covered. Inpatient We cover inpatient drugs as a hospital service. See Section 8.0 - definition of hospital services. Outpatient/In Your Doctor’s Office/In Your Home Generic, preferred brand name, or non-preferred brand name prescription drugs are covered at different benefit levels depending upon the route of administration. Our allowance for services rendered by the facilities, agencies, and professional providers may include the cost of the prescription drugs administered and/or dispensed. We will determine coverage based upon the route of administration that is customary and least invasive method to treat the condition. There are several ways to administer drugs into the body including:  inhalation (into the lungs, usually through the mouth);  intramuscular (injected into a muscle);  intra-articular (injected into a skeletal joint space);  intrathecal (injected into the space around the spinal cord);  intravenous/infused/intra-arterial (into a vein or artery);  nasal (sprayed into the nose);  ocular (instilled in the eye);  oral (by mouth);  rectal or vaginal (inserted into the rectum or vagina);  subcutaneous (injected beneath the skin);  sublingual (under the tongue);  topical (applied to the skin); OR  transdermal (delivered through the skin by a patch). Inhalation, Nasal, Ocular, Oral, Rectal Or Vaginal, Sublingual, Topical, And Transdermal Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs The prescription drug is included in our allowance for the medical service being rendered. If the sole service is drug dispensing, the prescription drug is NOT covered. Injected Generic, Preferred Brand Name Name, or Non-Preferred Brand Name Prescription Drugs We use the term injected to include prescription drugs approved by us given by intra muscular or subcutaneous injection or in the case of a body cavity by instillation. See the Summary of Medical Benefits for benefit limits and the amount that you pay. See Section 3.29 Prevention and Early Detection Services for immunization and vaccination coverage information. Infused Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs We use the term infused to include those prescription drugs approved by us and administered into a vein or into an artery whether by mixing in fluids and administering intravenously or into an artery, direct injection, or by use of a pump that accesses the vein or artery. See the Summary of Medical Benefits for benefit limits and the amount that you pay.

SPECIALTY PRESCRIPTION. DRUG is a type of prescription drug in our formulary that generally is identified by, but not limited to, features such as:  being produced by DNA technology,  treats chronic or long term disease,  requires customized clinical monitoring and patient support, and  needs special handling. Generally, specialty pharmacies dispense specialty prescription drugs. Contact Customer Service for further details and information about specialty prescription drugs and specialty pharmacies. For the purposes of this agreement, we have designated certain prescribed prescription drugs to be specialty prescription drugs in our formulary. To obtain coverage information for any specific specialty prescription drug or to obtain a copy of the most current formulary listing, visit our Web site at XXXXXX.xxx. Or, you may call our Customer Service Department at (000) 000-0000 or 0-000-000-0000. Generic, Preferred Brand Name or Non-Preferred Brand Name Prescription Drugs Generic, preferred brand name, or non-preferred brand name prescription drugs we have approved that are dispensed and administered by a licensed health care provider (other than a pharmacy) are covered under this agreement, subject to the copayment and deductible (if any) shown in the Summary of Medical Benefits. The generic, preferred brand name, or non- preferred brand name prescription drug must be dispensed per our dispensing guidelines in order to be covered. Inpatient We cover inpatient drugs as a hospital service. See Section 8.0 - definition of hospital services. Outpatient/In Your Doctor’s Office/In Your Home Generic, preferred brand name, or non-preferred brand name prescription drugs are covered at different benefit levels depending upon the route of administration. Our allowance for services rendered by the facilities, agencies, and professional providers may include the cost of the prescription drugs administered and/or dispensed. We will determine coverage based upon the route of administration that is customary and least invasive method to treat the condition. There are several ways to administer drugs into the body including:  inhalation (into the lungs, usually through the mouth);  intramuscular (injected into a muscle);  intra-articular (injected into a skeletal joint space);  intrathecal (injected into the space around the spinal cord);  intravenous/infused/intra-arterial (into a vein or artery);  nasal (sprayed into the nose);  ocular (instilled in the eye);  oral (by mouth);  rectal or vaginal (inserted into the rectum or vagina);  subcutaneous (injected beneath the skin);  sublingual (under the tongue);  topical (applied to the skin); OR  transdermal (delivered through the skin by a patch). Inhalation, Nasal, Ocular, Oral, Rectal Or Vaginal, Sublingual, Topical, And Transdermal Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs The prescription drug is included in our allowance for the medical service being rendered. If the sole service is drug dispensing, the prescription drug is NOT covered. Injected Generic, Preferred Brand Name or Non-Preferred Brand Name Prescription Drugs We use the term injected to include prescription drugs approved by us given by intra muscular or subcutaneous injection or in the case of a body cavity by instillation. See the Summary of Medical Benefits for benefit limits and the amount that you pay. See Section 3.29 - Prevention and Early Detection Services for immunization and vaccination coverage information. Infused Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs We use the term infused to include those prescription drugs approved by us and administered into a vein or into an artery whether by mixing in fluids and administering intravenously or into an artery, direct injection, or by use of a pump that accesses the vein or artery. See the Summary of Medical Benefits for benefit limits and the amount that you pay.

SPECIALTY PRESCRIPTION. DRUG is a type of prescription drug in our formulary that generally is identified by, but not limited to, features such as:  • being produced by DNA technology,  • treats chronic or long term disease,  • requires customized clinical monitoring and patient support, and  • needs special handling. Generally, specialty pharmacies dispense specialty prescription drugs. Contact Customer Service for further details and information about specialty prescription drugs and specialty pharmacies. For the purposes of this agreement, we have designated certain prescribed prescription drugs to be specialty prescription drugs in our formulary. To obtain coverage information for any specific specialty prescription drug or to obtain a copy of the most current formulary listing, visit our Web site at XXXXXX.xxx. Or, you may call our Customer Service Department at (000) 000-0000 or 0-000-000-0000. Generic, Preferred Brand Name Name, or Non-Preferred Brand Name Prescription Drugs Generic, preferred brand name, or non-preferred brand name prescription drugs we have approved that are dispensed and administered by a licensed health care provider (other than a pharmacy) are covered under this agreement, subject to the copayment and deductible (if any) shown in the Summary of Medical Benefits. The generic, preferred brand name, or non- preferred brand name prescription drug must be dispensed per our dispensing guidelines in order to be covered. Inpatient We cover inpatient drugs as a hospital service. See Section 8.0 - definition of hospital services. Outpatient/In Your Doctor’s Office/In Your Home Generic, preferred brand name, or non-preferred brand name prescription drugs are covered at different benefit levels depending upon the route of administration. Our allowance for services rendered by the facilities, agencies, and professional providers may include the cost of the prescription drugs administered and/or dispensed. We will determine coverage based upon the route of administration that is customary and least invasive method to treat the condition. There are several ways to administer drugs into the body including:  • inhalation (into the lungs, usually through the mouth);  • intramuscular (injected into a muscle);  • intra-articular (injected into a skeletal joint space);  • intrathecal (injected into the space around the spinal cord);  • intravenous/infused/intra-arterial (into a vein or artery);  • nasal (sprayed into the nose);  • ocular (instilled in the eye);  • oral (by mouth);  • rectal or vaginal (inserted into the rectum or vagina);  • subcutaneous (injected beneath the skin);  • sublingual (under the tongue);  • topical (applied to the skin); OR  • transdermal (delivered through the skin by a patch). Inhalation, Nasal, Ocular, Oral, Rectal Or Vaginal, Sublingual, Topical, And Transdermal Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs The prescription drug is included in our allowance for the medical service being rendered. If the sole service is drug dispensing, the prescription drug is NOT covered. Injected Generic, Preferred Brand Name Name, or Non-Preferred Brand Name Prescription Drugs We use the term injected to include prescription drugs approved by us given by intra muscular or subcutaneous injection or in the case of a body cavity by instillation. See the Summary of Medical Benefits for benefit limits and the amount that you pay. See Section 3.29 Prevention and Early Detection Services for immunization and vaccination coverage information. Infused Generic, Preferred Brand Name, or Non-Preferred Brand Name Prescription Drugs We use the term infused to include those prescription drugs approved by us and administered into a vein or into an artery whether by mixing in fluids and administering intravenously or into an artery, direct injection, or by use of a pump that accesses the vein or artery. See the Summary of Medical Benefits for benefit limits and the amount that you pay.