Formulary changes. Except in cases where patient safety is an issue, Contractor shall give affected Covered California Enrollees, and their prescribing physician(s), sixty (60) days written notice prior to the removal of a drug from formulary status, unless it is determined that a drug must be removed for safety purposes more quickly. If Contractor is not reasonably able to provide sixty (60) days written notice, the Contractor must provide affected Enrollees with a sixty (60) day period to access the drug as if was still on the formulary, that begins on the date the drug is removed from the formulary. This notice requirement shall apply only to single source brand drugs and the notice shall include information related to the appropriate substitute(s). The notice shall also comply with all requirements of the Health and Safety Code and Insurance Code, including provisions prohibiting Contractor from limiting or excluding coverage for a drug to a Plan Enrollee in cases where the drug had been previously approved for coverage by Contractor for a medical condition of the Plan Enrollee, except under specified conditions. To the extent permitted in State and Federal law, an exception to the notice requirement will be allowed when Contractor continues to cover a drug prescribed for a Plan Enrollee without interruption and under the same conditions, including copayment and limits that existed prior to the removal of the drug from formulary status.
Formulary changes. The formulary may change throughout the year. If you are affected by a formulary change, you will receive at least 30 days’ advanced notice of that change, and you may request a formulary exception. If our plan does not cover non-formulary drugs, and your physician prescribes a drug that is not on our formulary, you may request a review under the federal formulary exceptions process defined below.
Formulary changes. Except in cases where patient safety is an issue, Contractor shall give affected Covered California Enrollees, and their prescribing physician(s), sixty (60) Days’ written notice prior to the removal of a drug from formulary status, unless it is determined that a drug must be removed for safety purposes more quickly. If Contractor is not reasonably able to provide sixty (60) Days’ written notice, the Contractor must provide affected Covered California Enrollees with a sixty (60) Day period to access the drug as if was still on the formulary, that begins on the date the drug is removed from the formulary. This notice requirement shall apply only to single source brand drugs and the notice shall include information related to the appropriate substitute(s). The notice shall also comply with all requirements of the Health and Safety Code and Insurance Code, including provisions prohibiting Contractor from limiting or excluding coverage for a drug to a Covered California Enrollee in cases where the drug had been previously approved for coverage by Contractor for a medical condition of the Covered California Enrollee, except under specified conditions. To the extent permitted in State and Federal law, an exception to the notice requirement will be allowed when Contractor continues to cover a drug prescribed for a Covered California Enrollee without interruption and under the same conditions, including copayment and limits that existed prior to the removal of the drug from formulary status.
Formulary changes. United retains sole and complete control to (i) establish and amend the Formularies, and (ii) determine and amend all benefit structures and terms under any Benefit Plan. Following any changes or updates to the Formularies, Administrator, at United’s request, shall provide and/or make available appropriate notifications of such Formulary changes to Members, Network Pharmacies and state pharmaceutical assistance programs as required by applicable Laws and Regulations and as mutually agreed to by the Parties. Upon request by United and at United’s expense, Administrator shall provide to Members who have utilized the impacted Prescription Drug Services within the prior ninety (90) days, individual mailings of Formulary changes separate from the provision of EOBs.
