Common use of Brand Name Drugs Clause in Contracts

Brand Name Drugs. Brand Name Drugs are subject to the per Member, per Calendar Year Brand Name Drug Deductible as shown in the Summary of Benefits. Until the Brand Name Drug Deductible is satisfied, you are respon- sible for payment of 100% of the Participating Pharmacy contracted rate for the Drug to the Blue Shield Participating Pharmacy at the time the Drug is obtained. If the Plan’s contracted rate for the pre- scription is less than the Subscriber’s Copayment amount, the Subscriber is responsible for payment of the contracted rate only. The Copayment for Brand Name Drugs is shown in the Summary of Benefits. Note: Both the Formulary Brand Name Drug Co- payment and the Brand Name Drug Deductible ap- ply for diaphragms. There is a maximum Copayment of $150 per pre- scription for a Non-Formulary Brand Name Drug.

Brand Name Drugs. Brand Name Drugs are subject to the per Member, per Calendar Year Brand Name Drug Deductible as shown in the Summary of Benefits. Until the Brand Name Drug Deductible is satisfied, you are respon- sible for payment of 100% of the Participating Pharmacy contracted rate for the Drug to the Blue Shield Participating Pharmacy at the time the Drug is obtained. If the Plan’s contracted rate for the pre- scription is less than the Subscriber’s Copayment amount, the Subscriber is responsible for payment of the contracted rate only. The Copayment for Brand Name Drugs is shown in the Summary of Benefits. Note: Both the Formulary Brand Name Drug Co- payment and the Brand Name Drug Deductible ap- ply for diaphragms. There is a maximum Copayment of $150 per pre- scription for a Non-Formulary Brand Name DrugDrugs.