Common use of Authorization for Compound Prescriptions Clause in Contracts

Authorization for Compound Prescriptions. Compound prescriptions will require prior authorization by the Pharmacy Benefit Manager for any compounded claim with a single ingredient cost exceeding $300. Both prescription drug plans shall restrict generics. In the event the employee elects to receive a brand medication when a generic medication is available, the member shall pay the cost difference between the brand and generic medication, however, in the event a physician requires a brand medication, the employee shall not be responsible for the difference in cost. Both prescription plans shall provide/require that if an employee fills a prescription at retail more than twice, rather than utilizing mail-order, the member shall pay the difference. Except as otherwise provided herein, costs shall be shared as provided in §A. If, during the term of this Agreement, the parties agree to a Canadian drug program as an employee option, that plan may be implemented. Effective January 1, 2014, the Prescription Drug Plan will no longer offer the 90-day post formulary change grace period granted upon formulary changes. Plan participants affected by formulary changes shall be notified a minimum of 90 days prior to the effective date of the formulary change. The employer shall approve up to a 90 day post formulary change grace period for members based upon the members’ particular circumstances.