Common use of Designated Plan Pharmacy Benefit Payments Clause in Contracts

Designated Plan Pharmacy Benefit Payments. Benefits for Covered Drugs obtained at a Designated Plan Pharmacy are payable according to the applicable benefit tiers described below, subject to the Member obtaining any required Prior Authorization or meeting any applicable Step Therapy requirement.  Tier I – is the low Cost-share option for Covered Drugs.  Tier II – is the midrange Cost-share option for Covered Drugs.  Tier III – is the high Cost-share option for Covered Drugs.  Tier IV – is the highest Cost-share option for Covered Drugs.  Mandatory Generic benefit provision applies when:  a Brand Name Covered Drug is dispensed and a Generic Covered Drug equivalent is available. After satisfying any applicable CYD, the Member will pay the applicable tier Copayment and/or Coinsurance plus the difference between the Eligible Medical Expenses (“EME”) of the Generic Covered Drug and the EME of the Brand Name Covered Drug to the Designated Plan Pharmacy for each Therapeutic Supply. The difference in the amount between such Brand Name and Generic Covered Drug paid by the Member does not accumulate to any otherwise applicable plan Calendar Year Prescription Drug Deductible, overall plan CYD or annual Out of Pocket Maximum.

Designated Plan Pharmacy Benefit Payments. Benefits for Covered Drugs obtained at a Designated Plan Pharmacy are payable according to the applicable benefit tiers described below, subject to the Member Insured obtaining any required Prior Authorization or meeting any applicable Step Therapy requirement.  Tier I – is the low Cost-share option for Covered Drugs.  Tier II – is the midrange Cost-share option for Covered Drugs.  Tier III – is the high Cost-share option for Covered Drugs.  Tier IV – is the highest Cost-share option for Covered Drugs.  Mandatory Generic benefit provision applies when:  a Brand Name Covered Drug is dispensed and a Generic Covered Drug equivalent is available. After satisfying any applicable CYD, the Member Insured will pay the applicable tier Copayment and/or Coinsurance plus the difference between the Eligible Medical Expenses (“EME”) of the Generic Covered Drug and the EME of the Brand Name Covered Drug to the Designated Plan Pharmacy for each Therapeutic Supply. The difference in the amount between such Brand Name and Generic Covered Drug paid by the Member Insured does not accumulate to any otherwise applicable plan Calendar Year Prescription Drug Deductible, overall plan CYD or annual Out of Pocket Maximum.

Designated Plan Pharmacy Benefit Payments. Benefits for Covered Drugs obtained at a Designated Plan Pharmacy are payable according to the applicable benefit tiers described below, subject to the Member Insured obtaining any required Prior Authorization or meeting any applicable Step Therapy requirement.  • Tier I – is the low Cost-share option for Covered Drugs.  • Tier II – is the midrange Cost-share option for Covered Drugs.  • Tier III – is the high Cost-share option for Covered Drugs.  • Tier IV – is the highest Cost-share option for Covered Drugs.  • Mandatory Generic benefit provision applies when:  a Brand Name Covered Drug is dispensed and a Generic Covered Drug equivalent is available. After satisfying any applicable CYD, the Member Insured will pay the applicable tier Copayment and/or Coinsurance Cost-share plus the difference between the Eligible Medical Expenses (“EME”) of the Generic Covered Drug and the EME of the Brand Name Covered Drug to the Designated Plan Pharmacy for each Therapeutic Supply. The difference in the amount between such Brand Name and Generic Covered Drug paid by the Member Insured does not accumulate to any otherwise applicable plan Calendar Year Prescription Drug Deductible, overall plan CYD or annual Out of Pocket Maximum.

Designated Plan Pharmacy Benefit Payments. Benefits for Covered Drugs obtained at a Designated Plan Pharmacy are payable according to the applicable benefit tiers described below, subject to the Member Insured obtaining any required Prior Authorization or meeting any applicable Step Therapy requirement.  Tier I – is the low Cost-share option for Covered Drugs.  Tier II – is the midrange Cost-share option for Covered Drugs.  Tier III – is the high Cost-share option for Covered Drugs.  Tier IV – is the highest Cost-share option for Covered Drugs.  Mandatory Generic benefit provision applies when:  a Brand Name Covered Drug is dispensed and a Generic Covered Drug equivalent is available. After satisfying any applicable CYD, the Member Insured will pay the applicable tier Copayment and/or Coinsurance plus the difference between the Eligible Medical Expenses (“EME”) Expenses, or the Recognized Amount when applicable, of the Generic Covered Drug and the EME of the Brand Name Covered Drug to the Designated Plan Pharmacy for each Therapeutic Supply. The difference in the amount between such Brand Name and Generic Covered Drug paid by the Member Insured does not accumulate to any otherwise applicable plan Calendar Year Prescription Drug Deductible, overall plan CYD or annual Out of Pocket Maximum.

Designated Plan Pharmacy Benefit Payments. Benefits for Covered Drugs obtained at a Designated Plan Pharmacy are payable according to the applicable benefit tiers described below, subject to the Member Insured obtaining any required Prior Authorization or meeting any applicable Step Therapy requirement.  Tier I – is the low Cost-share option for Covered Drugs.  Tier II – is the midrange Cost-share option for Covered Drugs.  Tier III – is the high Cost-share option for Covered Drugs.  Tier IV – is the highest Cost-share option for Covered Drugs.  Mandatory Generic benefit provision applies when:  a Brand Name Covered Drug is dispensed and a Generic Covered Drug equivalent is available. After satisfying any applicable CYD, the Member Insured will pay the applicable tier Copayment and/or Coinsurance plus the difference between the Eligible Medical Expenses (“EME”) of the Generic Covered Drug and the EME of the Brand Name Covered Drug to the Designated Plan Pharmacy for each Therapeutic Supply. The difference in the amount between such Brand Name and Generic Covered Drug paid by the Member Insured does not accumulate to any otherwise applicable plan Calendar Year Prescription Drug Deductible, overall plan CYD or annual Out of Pocket Maximum. When a Drug is dispensed through the Mail Order Plan Pharmacy, benefits are subject to the applicable tier Copayment and/or Coinsurance per Mail Order Therapeutic Supply.

Designated Plan Pharmacy Benefit Payments. Benefits for Covered Drugs obtained at a Designated Plan Pharmacy are payable according to the applicable benefit tiers described below, subject to the Member obtaining any required Prior Authorization or meeting any applicable Step Therapy requirement.  • Tier I – is the low Cost-share option for Covered Drugs.  • Tier II – is the midrange Cost-share option for Covered Drugs.  • Tier III – is the high Cost-share option for Covered Drugs.  • Tier IV – is the highest Cost-share option for Covered Drugs.  • Mandatory Generic benefit provision applies when:  • a Brand Name Covered Drug is dispensed and a Generic Covered Drug equivalent is available. After satisfying any applicable CYD, the Member will pay the applicable tier Copayment and/or Coinsurance plus the difference between the Eligible Medical Expenses (“EME”) of the Generic Covered Drug and the EME of the Brand Name Covered Drug to the Designated Plan Pharmacy for each Therapeutic Supply. The difference in the amount between such Brand Name and Generic Covered Drug paid by the Member does not accumulate to any otherwise applicable plan Calendar Year Prescription Drug Deductible, overall plan CYD or annual Out of Pocket Maximum. When a Drug is dispensed through the Mail Order Plan Pharmacy, benefits are subject to the applicable tier Copayment and/or Coinsurance per Mail Order Therapeutic Supply.

Designated Plan Pharmacy Benefit Payments. Benefits for Covered Drugs obtained at a Designated Plan Pharmacy are payable according to the applicable benefit tiers described below, subject to the Member obtaining any required Prior Authorization or meeting any applicable Step Therapy requirement.  Tier I – is the low Cost-share option for Covered Drugs.  Tier II – is the midrange Cost-share option for Covered Drugs.  Tier III – is the high Cost-share option for Covered Drugs.  Tier IV – is the highest Cost-share option for Covered Drugs.  Mandatory Generic benefit provision applies when:  a Brand Name Covered Drug is dispensed and a Generic Covered Drug equivalent is available. After satisfying any applicable CYD, the Member will pay the applicable tier Copayment and/or Coinsurance plus the difference between the Eligible Medical Expenses (“EME”) Expenses, or the Recognized Amount when applicable, of the Generic Covered Drug and the EME of the Brand Name Covered Drug to the Designated Plan Pharmacy for each Therapeutic Supply. The difference in the amount between such Brand Name and Generic Covered Drug paid by the Member does not accumulate to any otherwise applicable plan Calendar Year Prescription Drug Deductible, overall plan CYD or annual Out of Pocket Maximum.