Common use of Dispensing Limits Clause in Contracts

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. Day Supply 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 under this Benefit Section. For additional information about early refills, please see the Pre­ scription Refills provision below.

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. Day Supply 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 chronic condition of the eye will be eligible xxx­ gible 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 pre­ scribing 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 under this Benefit Section. For additional information about early refills, please see the Pre­ scription Refills provision below.

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 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 al- lows. Payment for benefits covered under this section may be denied if drugs are dis­ 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. Day Supply In order to be eligible for coverage under this Certificate, the prescribed day sup­ 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 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 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 under this Benefit Section. For additional information about early refills, please see the Pre­ Pre- scription Refills provision below.