Generic Step Therapy Sample Clauses

Generic Step Therapy. “Targeted Generic Step Therapy” will be implemented in the Caremark prescription plan to promote greater use of generic drugs in the case of certain drugs for identified medical conditions; as provided in a separate Memorandum of Understanding regarding Generic Step Therapy between MCPS, MCEA, SEIU Local 500 and MCAAP.
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Generic Step Therapy. Requires the use of cost-effective generic alternatives within the same therapeutic class, as first line therapy before brand name prescriptions are covered.
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Generic Step Therapy a program that requires plan members use cost-effective alternatives within the same therapeutic class, as first line therapy before brand name prescriptions are covered. The program includes an appeals process that would allow the member and provider to request an exception to this requirement in medically necessary circumstances. The County shall provide written and electronic notification to the Union and electronic notification to all Bargaining Unit Members of any medications and/or targeted classes that are to be added to the generic step therapy list at least 30 calendar days prior to the effective date of the change(s). The PBM shall also provide written notice to an affected member whenever any medication(s) he/she is taking will be added to the generic step therapy list at least 30 calendar days prior to the effective date of the change(s). Notification to the affected member shall include a list of generic alternative medications that the member may take to the treating physician to discuss treatment options. However, any member who is taking a specialty medication at the time of notification shall be grandfathered, meaning that he/she shall be allowed to continue taking the non-generic specialty medication at the member’s cost identified in the prescription plan negotiated by the Union and the Employer for as long as his/her treating physician prescribes such medication. In instances where a member’s prescription is rejected because a generic alternative exists and the member’s doctor is unavailable for consultation, the Union, on behalf of the member, may petition17 the County benefit office to intervene with the PBM and request that the doctor’s prescription be filled as written. The County agrees to work with the Union and the PBM to ensure the member does not go without the needed medication.
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Generic Step Therapy a program that requires plan members use cost-effective alternatives within the same therapeutic class, as first line therapy before brand name prescriptions are covered. The program includes an appeals process that would allow the member and provider to request an exception to this requirement in medically necessary circumstances. The County shall provide written and electronic notification to the Union and electronic notification to all Bargaining Unit Members of any medications and/or targeted classes that are to be added to the generic step therapy list at least 30 calendar days prior to the effective date of the change(s). The PBM shall also provide written notice to an affected member whenever any medication(s) he/she is taking will be added to the generic step therapy list at least 30 calendar days prior to the effective date of the change(s). Notification to the affected member shall include a list of generic alternative medications that 10 Per action taken on May 26, 2011, the County Council did not approve full funding for this provision. On that date, the Council adopted a different cost-sharing arrangement for bargaining unit employees, to become effective on January 1, 2012. See Appendix V. 11 For the duration of this contract (July 1, 2017 – June 30, 2019) PBM’s pharmacy network refers to CVS Pharmacies. the member may take to the treating physician to discuss treatment options. However, any member who is taking a specialty medication at the time of notification shall be grandfathered, meaning that he/she shall be allowed to continue taking the non-generic specialty medication at the member’s cost identified in the prescription plan negotiated by the Union and the Employer for as long as his/her treating physician prescribes such medication. In instances where a member’s prescription is rejected because a generic alternative exists and the member’s doctor is unavailable for consultation, the Union, on behalf of the member, may petition 12 the County benefit office to intervene with the PBM and request that the doctor’s prescription be filled as written. The County agrees to work with the Union and the PBM to ensure the member does not go without the needed medication.
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Related to Generic Step Therapy

  • Infusion Therapy the administration of antibiotic, nutrients, or other therapeutic agents by direct infusion. Note: The limitations on Therapy Services contained in this Therapy Services provision do not apply to any Therapy Services that are received under the Home Health Care provision or to therapy services received under the Diagnosis and Treatment of Autism or Other Developmental Disabilities provision. .

  • Commercialization Intrexon shall have the right to develop and Commercialize the Reverted Products itself or with one or more Third Parties, and shall have the right, without obligation to Fibrocell, to take any such actions in connection with such activities as Intrexon (or its designee), at its discretion, deems appropriate.

  • Therapies Acupuncture and acupuncturist services, including x-ray and laboratory services. • Biofeedback, biofeedback training, and biofeedback by any other modality for any condition. • Recreational therapy services and programs, including wilderness programs. • Services provided in any covered program that are recreational therapy services, including wilderness programs, educational services, complimentary services, non- medical self-care, self-help programs, or non-clinical services. Examples include, but are not limited to, Tai Chi, yoga, personal training, meditation. • Computer/internet/social media based services and/or programs. • Recreational therapy. • Aqua therapy unless provided by a physical therapist. • Maintenance therapy services unless it is a habilitative service that helps a person keep, learn or improve skills and functioning for daily living. • Aromatherapy. • Hippotherapy. • Massage therapy rendered by a massage therapist. • Therapies, procedures, and services for the purpose of relieving stress. • Physical, occupational, speech, or respiratory therapy provided in your home, unless through a home care program. • Pelvic floor electrical and magnetic stimulation, and pelvic floor exercises. • Educational classes and services for speech impairments that are self-correcting. • Speech therapy services related to food aversion or texture disorders. • Exercise therapy. • Naturopathic, homeopathic, and Christian Science services, regardless of who orders or provides the services. Vision Care Services • Eye exercises and visual training services. • Lenses and/or frames and contact lenses for members aged nineteen (19) and older. • Vision hardware purchased from a non-network provider. • Non-collection vision hardware. • Lenses and/or frames and contact lenses unless specifically listed as a covered healthcare service.

  • Diagnostic procedures to aid the Provider in determining required dental treatment.

  • Biological Samples If so specified in the Protocol, Institution and Principal Investigator may collect and provide to Sponsor or its designee Biological Samples (“Biological Samples”). 12.2.

  • Hepatitis B Vaccine Where the Hospital identifies high risk areas where employees are exposed to Hepatitis B, the Hospital will provide, at no cost to the employees, a Hepatitis B vaccine.

  • Licensed Products Lessee will obtain no title to Licensed Products which will at all times remain the property of the owner of the Licensed Products. A license from the owner may be required and it is Lessee's responsibility to obtain any required license before the use of the Licensed Products. Lessee agrees to treat the Licensed Products as confidential information of the owner, to observe all copyright restrictions, and not to reproduce or sell the Licensed Products.

  • Clinical 2.1 Provides comprehensive evidence based nursing care to patients including assessment, intervention and evaluation.

  • Influenza Vaccine Upon recommendation of the Medical Officer of Health, all employees shall be required, on an annual basis to be vaccinated and or to take antiviral medication for influenza. If the costs of such medication are not covered by some other sources, the Employer will pay the cost for such medication. If the employee fails to take the required medication, she may be placed on an unpaid leave of absence during any influenza outbreak in the home until such time as the employee has been cleared by the public health or the Employer to return to the work environment. The only exception to this would be employees for whom taking the medication will result in the employee being physically ill to the extent that she cannot attend work. Upon written direction from the employee’s physician of such medical condition in consultation with the Employer’s physician, (if requested), the employee will be permitted to access their sick bank, if any, during any outbreak period. If there is a dispute between the physicians, the employee will be placed on unpaid leave. If the employee gets sick as a reaction to the drug and applies for WSIB the Employer will not oppose the application. If an employee is pregnant and her physician believes the pregnancy could be in jeopardy as a result of the influenza inoculation and/or the antiviral medication she shall be eligible for sick leave in circumstances where she is not allowed to attend at work as a result of an outbreak. This clause shall be interpreted in a manner consistent with the Ontario Human Rights Code.

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