In-Network Pharmacies Sample Clauses

In-Network Pharmacies. The following prescription drug coverage will apply for prescription drugs purchased at in-network pharmacies for up to a 30-day supply:  The copay for generic drugs will be the Discounted Network Price (“DNP”) for the original prescription and each refill, with a maximum copay of $10 for 2019, 2020, and 2021.  The copay for brand name preferred drugs will be 20% of the DNP for the original prescription and each refill, with a maximum copay of $30 for 2019 and 2020, and for each calendar year thereafter, the maximum copay will increase when compared to the maximum copay for the prior calendar year by the percent equal to the percent increase in the per prescription cost of all non-compound brand name drugs (preferred and non-preferred) in the prescription drug program for Mid-Atlantic active employees between the year that was three years prior and the year that was two years prior, up to a maximum of 6% (the “Brand Trend Percentage”). For example, and solely for avoidance of doubt, for calendar year 2022, the maximum copay for brand name preferred drugs will increase by the percent equal to the percent increase in the per prescription cost of non- compound brand name drugs (preferred and non-preferred) in the prescription drug program for Mid-Atlantic active employees between 2019 and 2020 up to a maximum of 6%. If between 2019 and 2020 the per prescription cost of non-compound brand name drugs (preferred and non-preferred) in the prescription drug program for Mid-Atlantic active employees increases by 15%, then the Brand Trend Percentage for 2022 shall be 6% and the 2022 maximum copay for brand preferred drugs shall be an amount that is 6% greater than the 2021 maximum copay for brand preferred drugs.  The copay for brand name non-preferred drugs will be 30% of the DNP for the original prescription and each refill, with a maximum copay of $40 for 2019 and 2020 and for each calendar year thereafter, the maximum copay will increase when compared to the maximum copay for the prior calendar year by the applicable Brand Trend Percentage. For example, and solely for avoidance of doubt, for calendar year 2021, the maximum copay for brand name non-preferred drugs will increase by the percent equal to the percent increase in the per prescription cost of non-compound brand name drugs (preferred and non-preferred) in the prescription drug program for Mid-Atlantic active employees between 2018 and 2019, up to a maximum of 6%. If between 2018 and 2019, the per pre...
Sample 1
AutoNDA by SimpleDocs
In-Network Pharmacies. The following prescription drug coverage will apply for prescription drugs purchased at in-network pharmacies for up to a 30-day supply: • The copay for generic drugs will be the Discounted Network Price (“DNP”) for the original prescription and each refill, with a maximum copay of $8 for each of 2013 and 2014, and $9 for 2015. • The copay for single-source and multi-source brand name drugs will be 30% of the DNP for the original prescription and each refill, with a maximum copay of $25 for each of 2013 and 2014, and for 2015 and each calendar year thereafter, the maximum copay will increase by 6% when compared with the maximum copay for the prior Plan Year. • If an associate purchases a brand name drug when a generic equivalent is available, the associate will pay an amount equal to (a) the DNP, up to a maximum of $8 for each of 2013 and 2014, or $9 for 2015, plus (b) 100% of the cost difference between the brand name and generic drug, and the fixed dollar maximum copays described above will not apply. If the associate’s treating physician certifies that the associate is medically unable to take the generic medication and such exception is approved by the TPA’s procedures for approval of treatment or services, then the single source and multi-source coverage will apply. • Once an associate has obtained three fills of the prescription from an in- network pharmacy (i.e., the initial prescription plus two refills), then the associate must use the mail order pharmacy to obtain subsequent refills of long-term prescription medications. If an associate does not use the mail order pharmacy to obtain such subsequent refills of a long-term prescription medication, an associate will be responsible for 50% of the DNP cost for subsequent refills of a long-term prescription medication. The fixed dollar maximum copays described above will not apply.
Sample 1

Related to In-Network Pharmacies

  • Online Services Microsoft warrants that each Online Service will perform in accordance with the applicable SLA during Customer’s use. Customer’s remedies for breach of this warranty are described in the SLA.

  • NON-NETWORK PROVIDER is a provider that has not entered into a contract with us or any other Blue Cross and Blue Shield plan. For pediatric dental care services, non-network provider is a dentist that has not entered into a contract with us or does not participate in the Dental Coast to Coast Network. For pediatric vision hardware services, a non-network provider is a provider that has not entered into a contract with EyeMed, our vision care service manager.

  • End Users Customer will control access to and use of the Products by End Users and is responsible for any use of the Products that does not comply with this Agreement.

  • Telemedicine Services This plan covers clinically appropriate telemedicine services when the service is provided via remote access through an on-line service or other interactive audio and video telecommunications system in accordance with R.I. General Law § 27-81-1. Clinically appropriate telemedicine services may be obtained from a network or non- network provider, and from our designated telemedicine service provider. When you seek telemedicine services from our designated telemedicine service provider, the amount you pay is listed in the Summary of Medical Benefits. When you receive a covered healthcare service from a network or non-network provider via remote access, the amount you pay depends on the covered healthcare service you receive, as indicated in the Summary of Medical Benefits. For information about telemedicine services, our designated telemedicine service provider, and how to access telemedicine services, please visit our website or contact our Customer Service Department.

  • Pharmacy Pharmacy hereby represents that neither Pharmacy, nor, to the best of Pharmacy’s knowledge, Pharmacist, Pharmacy’s employees, agents or independent

  • Provider Network The Panel of health service Providers with which the Contractor contracts for the provision of covered services to Members and Out-of-network Providers administering services to Members.

  • Hospice Services Services are available for a Member whose Attending Physician has determined the Member's illness will result in a remaining life span of six months or less.

  • Anesthesia Services This plan covers general and local anesthesia services received from an anesthesiologist when the surgical procedure is a covered healthcare service. This plan covers office visits or office consultations with an anesthesiologist when provided prior to a scheduled covered surgical procedure.

  • Supplier Diversity Seller shall comply with Xxxxx’s Supplier Diversity Program in accordance with Appendix V.

  • Surgery Services This plan covers surgery services to treat a disease or injury when: • the operation is not experimental or investigational, or cosmetic in nature; • the operation is being performed at the appropriate place of service; and • the physician is licensed to perform the surgery. This plan covers reconstructive surgery and procedures when the services are performed to relieve pain, or to correct or improve bodily function that is impaired as a result of: • a birth defect; • an accidental injury; • a disease; or • a previous covered surgical procedure. Functional indications for surgical correction do not include psychological, psychiatric or emotional reasons. This plan covers the procedures listed below to treat functional impairments. • abdominal wall surgery including panniculectomy (other than an abdominoplasty); • blepharoplasty and ptosis repair; • gastric bypass or gastric banding; • nasal reconstruction and septorhinoplasty; • orthognathic surgery including mandibular and maxillary osteotomy; • reduction mammoplasty; • removal of breast implants; • removal or treatment of proliferative vascular lesions and hemangiomas; • treatment of varicose veins; or • gynecomastia.

Draft better contracts in just 5 minutes Get the weekly Law Insider newsletter packed with expert videos, webinars, ebooks, and more!