COMPOUND DRUGS Sample Clauses
COMPOUND DRUGS mean those drugs or inert ingredients that have been measured and mixed by a pharmacist to produce a unique formulation because commercial products either do not exist or do not exist in the correct dosage, size, or form. COPAYMENT AMOUNT means the dollar amount paid by you for each Prescription filled or refilled through a Participating Pharmacy or non‐Partic ipating Pharmacy. COVERED DRUGS. means any Legend Drug (except insulin, insulin ▇▇▇ logs, insulin pens, and prescriptive and non‐prescriptive oral agents for controlling blood sugar levels, including disposable syringes and needles needed for self administration):
COMPOUND DRUGS mean those drugs or inert ingredients that have been measured and mixed with United States Food and Drug Administration (FDA)‐approved pharmaceutical ingredients by a pharmacist to produce a unique formulation that is medically necessary because commercial products either do not exist or do not exist in the correct dosage, size, or form. COPAYMENT AMOUNT means the dollar amount paid by you for each Prescription Order filled or refilled through a Participating Pharmacy or non‐ Participating Pharmacy.
COMPOUND DRUGS. Medications in depot or long acting formulations that are intended for use longer than the covered days supply amount.
COMPOUND DRUGS. Unless otherwise required by law, or is otherwise determined by Anthem to be Medically Necessary. In order for that Compound Drug to be considered Medically Necessary, the doctor must substantiate to Anthem, in writing, a statement that includes the reasons why use of that Compound Drug is more medically beneficial than the clinically equivalent alternative. Corrective Eye Surgery. For eye surgery to correct errors of refraction, such as near-sightedness, including without limitation LASIK, radial keratotomy or keratomileusis, or excimer laser refractive keratectomy. Cosmetic Services. Provided in connection with cosmetic services. Cosmetic services are primarily intended to preserve, change or improve Your appearance or are furnished for social reasons. No benefits are available for surgery or treatments to change the texture or appearance of Your skin or to change the size, shape or appearance of facial or body features (such as Your nose, eyes, ears, cheeks, chin, chest or breasts). Complications directly related to cosmetic services, treatment or surgery, as determined by Us, are not covered. This exclusion applies even if the original cosmetic services treatment or surgery was performed while the Member was covered by another carrier/self-funded plan prior to coverage under this Contract. Directly related means that the treatment or surgery occurred as a direct result of the cosmetic services treatment or surgery and would not have taken place in the absence of the cosmetic services treatment or surgery. This exclusion does not apply to conditions including, but not limited to, myocardial infarction; pulmonary embolism; thrombophlebitis; and exacerbation of co-morbid conditions. This exclusion also does not apply to plastic or reconstructive surgery to restore breast symmetry by reduction mammoplasty, mastopexy or breast augmentation as recommended by the oncologist or PCP for a Member incident to a covered mastectomy. Coverage will include reduction or uplift surgery on the unaffected breast to produce a symmetrical appearance.
COMPOUND DRUGS. CHLIC shall process prescribed Compound Drugs to the extent covered under the Plan. CHLIC shall treat as Covered Drugs only those components of a Compound Drug that would otherwise be treated as Covered Drugs were they not part of a Compound Drug.
COMPOUND DRUGS mean those drugs or inert ingredients that have been measured and mixed by a pharmacist to produce a unique formulation because commercial products either do not exist or do not exist in the correct dosage, size, or form.
COMPOUND DRUGS mean those drugs or inert ingredients that have been measured and mixed with United States Food and Drug Administration (FDA)‐approved pharmaceutical ingredients by a pharmacist to produce a unique formulation because commercial products either do not exist or do not exist in the correct dosage, size, or form. COPAYMENT AMOUNT means the dollar amount paid by you for each Prescription filled or refilled through a Participating Pharmacy or non‐Partic ipating Pharmacy. COVERED DRUGS. means any Legend Drug (except insulin, insulin ▇▇▇ logs, insulin pens, and prescriptive and non‐prescriptive oral agents for controlling blood sugar levels, including disposable syringes and needles needed for self administration):
COMPOUND DRUGS. Compound drugs dispensed at retail, mail order and specialty pharmacy shall be reimbursed using the National Council for Prescription Drug Programs (NCPDP) multi-ingredient transaction. Compound claims shall be adjudicated based on an allowable ingredient costs for each NDC using lesser of logic—comparing the discounted AWP cost, MAC price (if applicable), and the submitted ingredient cost for each ingredient of the compound. The individual allowable ingredient costs for each NDC are added to create a Total Final Ingredient Cost for the claim. The Total Calculated Cost shall equal the Total Final Ingredient Cost, plus the pharmacy’s contracted dispensing fee, plus the pharmacy’s contracted Professional Service Fee (if any). The final gross charge for the compound claim shall equal the lesser of the Total Calculated Cost and the pharmacy-submitted total Usual & Customary price for the compound. Zero Pay Claims. The calculation of all proposed AWP discount guarantees (e.g., retail brand, retail generic, mail brand, mail generic, specialty pharmacy) shall include zero pay claims (claims where the participant pays the full cost of the drug, and the Plan pays zero) based on the actual adjudicated Ingredient Cost; the AWP discount for zero pay claims shall not be included at one hundred percent (100%) discount.