Common use of Dispensing Limits Clause in Contracts

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. Using In-network Pharmacies 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 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. Using In-network Pharmacies When you use an in-network pharmacy, always show your Premera LifeWise 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 LifeWise 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.