Dispensing Limits. Drug dispensing limits are designed to help encourage medication use as intended by the FDA. Coverage limits are placed on medications in certain drug categories. Limits may include: quantity of covered medication per prescription, quantity of covered medication in a given time period, coverage only for members within a certain age range and coverage only for members of a specific gender. The Plan evaluates and updates dispensing limits quarterly. If you require a prescription in excess of the dispensing limit established by the Plan, ask your Health Care Practitioner to submit a request for clinical review on your behalf. The request will be approved or denied after evaluation of the sub mitted clinical information. If medically necessary criteria is not met, you will be responsible for the full cost of the prescription beyond what your coverage al lows. Payment for benefits covered under this section may be denied if drugs are dis pensed or delivered in a manner intended to change, or having the effect of changing or circumventing, the stated maximum quantity limitation. To determine if a specific drug is subject to this limitation, you can refer to the Plan's website at xxx.xxxxxx.xxx or call the customer service toll-free number on your identification card. In order to be eligible for coverage under this Certificate, the prescribed day sup ply must be medically necessary and must not exceed the maximum day supply limitation described in this Certificate. The Plan has the right to determine the day supply. Payment for benefits covered under this benefit section may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumventing, the stated maximum day supply limitation. Specialty Drugs are limited to a 30 day supply. For information on these drugs call the customer service toll-free number located on your identification card. However, early prescription refills of topical eye medication used to treat a chron ic condition of the eye will be eligible for coverage after at least 75% of the predicted days of use and the early refills requested do not exceed the total number of refills prescribed by the prescribing Physician or Optometrist. Benefits for pre scription inhalants will not be restricted on the number of days before an inhaler refill may be obtained. However, you may receive coverage for up to a 12‐month supply for dispensed contraceptive drugs and products that are covered und...
Dispensing Limits. If a Prescription Order is written for a certain quantity of medication to be taken in a time period directed by your Physician, Dentist, Optometrist or Podiatrist, coverage will only be provided for a clinically appropriate pre‐determined max imum quantity of medication for the specified amount of time. Dispensing limits are based upon FDA dosing recommendations and nationally recognized clinical guidelines.
Dispensing Limits. Drug dispensing limits are designed to help encourage medication use as intended by the FDA. Coverage limits are placed on medications in certain drug categories. Limits may include: quantity of covered medication per prescription, quantity of covered medication in a given time period, coverage only for members within a certain age range. The Plan evaluates and updates dispensing limits quarterly or annually. If you require a prescription in excess of the dispensing limit established by the Plan, ask your Health Care Practitioner to submit a request for clinical review on your behalf. The request will be approved or denied after evaluation of the submitted clinical information. If medically necessary criteria is not met, you will be responsible for the full cost of the prescription beyond what your coverage allows. Payment for benefits covered under this section may be denied if drugs are dispensed or delivered in a manner intended to change, or having the effect of changing or circumventing, the stated maximum quantity limitation. To determine if a specific drug is subject to this limitation, you can refer to the Plan's website at xxx.xxxxxx.xxx or call the customer service toll‐free number on your identification card.
Dispensing Limits. The quantity of Prescription Drugs dispensed pursuant to a Prescription Order or refill will be that quantity usually prescribed by the Physician, not to exceed the quantity required for 34 consecutive days supply with the following exceptions:
Dispensing Limits. Benefits are limited to a certain number of days’ supply as shown in the Summary of Your Costs. Sometimes a drug maker’s packaging may affect the supply in some other way. We will cover a supply greater than normally allowed under your plan if the packaging does not allow a lesser amount. Exceptions to this limit may be allowed as required by law. For example a pharmacist can authorize an early refill of a prescription for topical ophthalmic products in certain circumstances. You must pay a copayment for each limited days’ supply. When you use an in-network pharmacy, always show your Premera ID Card. As a member, you will not be charged more than the allowed amount for each prescription or refill. The pharmacy will also submit your claims to us. You only have to pay the deductible, copayment or coinsurance as shown in the Summary of Your Costs. If you do not show your Premera ID Card, you will be charged the full retail cost. Then you must send us your claim for reimbursement. Reimbursement is based on the allowed amount. See Sending Us a Claim for instructions. This plan does not cover prescription drugs from out-of-network pharmacies.
Dispensing Limits. Benefits are limited to a certain number of days’ supply as shown in the
Dispensing Limits. Benefits are limited to a certain number of days’ supply as shown in the Summary of Your Costs. Sometimes a drug maker’s packaging may affect the supply in some other way. We will cover a supply greater than normally allowed under your plan if the packaging does not allow a lesser amount. Exceptions to this limit may be allowed as required by law. For example a pharmacist can authorize an early refill of a prescription for topical ophthalmic products in certain circumstances. You must pay a copayment for each limited days’ supply.
