Common use of Formulary changes Clause in Contracts

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. Except in cases where patient safety is an issue, Contractor shall give affected Covered California Enrollees, and their prescribing physician(s), sixty (60) DaysdaysDays’ 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) DaysdaysDays’ written notice, the Contractor must provide affected Covered California Enrollees with a sixty (60) Day dayDay 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 CaliforniaPlan Enrollee in cases where the drug had been previously approved for coverage by Contractor for a medical condition of the Covered California 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 Covered California CaliforniaPlan 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. 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 CaliforniaPlan Enrollee in cases where the drug had been previously approved for coverage by Contractor for a medical condition of the Covered California 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 Covered California CaliforniaPlan Enrollee without interruption and under the same conditions, including copayment and limits that existed prior to the removal of the drug from formulary status.